Key result
Adaptive left ventricular-only pacing was associated with a lower risk of death, HF hospitalization, and appropriate ICD therapy compared to conventional BVP (HR 0.56; 95% CI 0.36-0.85; p=0.007).
Why the study?
Conflicting results have been reported on the efficacy of adaptive left ventricular-only pacing for CRT in Western heart failure populations, prompting evaluation in Asian patients.
Does adaptive left ventricular-only pacing reduce the composite of all-cause death, heart failure hospitalization, and appropriate ICD therapy compared to conventional biventricular pacing in Asian heart failure patients receiving CRT?
Cohort (n=368)
Yes
Does adaptive left ventricular-only pacing reduce the composite of all-cause death, heart failure hospitalization, and appropriate ICD therapy compared to conventional biventricular pacing in Asian heart failure patients receiving CRT?
Hazard Ratio: 0.56 (95% CI 0.36–0.85)
p-value: p=0.007
In Asian heart failure patients receiving CRT, adaptive left ventricular-only pacing significantly reduced the composite risk of death, heart failure hospitalization, and appropriate ICD therapy compared to conventional biventricular pacing.
Adaptive LVP was associated with lower composite events than conventional BVP in Asian HF; leaves open whether it should replace BVP pending randomized trials.
BACKGROUND AND OBJECTIVES: Conflicting results have been reported regarding the efficacy of left ventricular-only pacing (LVP) synchronized with intrinsic right ventricular conduction (adaptive LVP) for cardiac resynchronization therapy (CRT) in Western heart failure (HF) populations. We compared adaptive LVP with conventional biventricular pacing (BVP) in Asian HF patients. METHODS: The K-adaptive CRT study, the largest adaptive CRT study to date in Asian HF patients, evaluated 368 HF patients who received CRT devices with an adaptive pacing algorithm between September 2013 and March 2020 from 25 tertiary hospitals in Korea. Patients were classified into 3 groups according to their pacing configuration: adaptive LVP (n=160), adaptive BVP (n=86), and conventional BVP groups (n=122). Primary outcome was the composite of all-cause death, HF hospitalization, and appropriate implantable cardioverter-defibrillator therapy. RESULTS: During the mean 3.7-year follow-up period, incidence of the primary outcome was significantly lower in the adaptive LVP group than the conventional BVP group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.36-0.85; p=0.007), while outcomes in the adaptive and conventional BVP groups were comparable. Patients with higher LVP% (≥65%) showed a further reduction in relative risk of the primary outcome (HR, 0.41; 95% CI, 0.22-0.76; p=0.005). Adaptive LVP was consistently associated with a lower risk of clinical outcomes in various subgroup analyses, and was identified as an independent factor for favorable long-term outcomes. CONCLUSIONS: The K-adaptive CRT study suggests that adaptive LVP is associated with better clinical outcomes than conventional BVP in Asian HF patients.
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Gwag et al. (2025) conducted a cohort in Heart failure (n=368). Adaptive left ventricular-only pacing (LVP) vs. Conventional biventricular pacing (BVP) was evaluated on Composite of all-cause death, HF hospitalization, and appropriate implantable cardioverter-defibrillator therapy (HR 0.56, 95% CI 0.36-0.85, p=0.007). Adaptive left ventricular-only pacing was associated with a lower risk of death, HF hospitalization, and appropriate ICD therapy compared to conventional BVP (HR 0.56; 95% CI 0.36-0.85; p=0.007).
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