Volume 16, Issue 7, Pages 983-989 (July 2019) Adaptive cardiac resynchronization therapy is associated with decreased risk of incident atrial fibrillation compared to standard biventricular pacing: A real-world analysis of 37,450 patients followed by remote monitoring  Jonathan C. Hsu, MD, MAS, FHRS, David Birnie, MD, MB, ChB, Robert W. Stadler, PhD, Jeffrey Cerkvenik, MS, Gregory K. Feld, MD, FHRS, Ulrika Birgersdotter-Green, MD, FHRS  Heart Rhythm  Volume 16, Issue 7, Pages 983-989 (July 2019) DOI: 10.1016/j.hrthm.2019.05.012 Copyright © 2019 The Authors Terms and Conditions

Figure 1 Unadjusted Kaplan-Meier estimates of cumulative incidence of developing 48 hours of atrial fibrillation (AF) among 37,450 cardiac resynchronization therapy (CRT) patients followed in the Medtronic CareLink remote monitoring database stratified by programmed mode of biventricular (BiV) pacing (AdaptivCRT algorithm [aCRT] off, green line; adaptive BiV pacing, red line; adaptive BiV and left ventricular (LV) pacing, purple line) over 3 years of follow-up. Adjusted hazard ratio (HR) (95% confidence interval) and P values shown in the inset represent Cox proportional hazards regression estimates for the outcome of developing 48 hours of AF in the 2 aCRT pacing modes vs standard BiV pacing mode, adjusting for age and sex. Heart Rhythm 2019 16, 983-989DOI: (10.1016/j.hrthm.2019.05.012) Copyright © 2019 The Authors Terms and Conditions

Figure 2 Unadjusted Kaplan-Meier estimates of cumulative incidence of developing 48 hours of atrial fibrillation (AF) among increasing quartiles of left ventricular (LV)-only pacing in patients programmed to AdaptivCRT algorithm (aCRT) pacing with adaptive biventricular (BiV) and LV pacing, with quartile 1 (0%–5% LV-only pacing; blue line), quartile 2 (5%–59% LV-only pacing; black line), quartile 3 (59%–92% LV-only pacing; green line), and quartile 4 (>92% LV-only pacing; purple line) shown over 3 years of follow-up. Log rank test for comparison, P <.001. Heart Rhythm 2019 16, 983-989DOI: (10.1016/j.hrthm.2019.05.012) Copyright © 2019 The Authors Terms and Conditions

Figure 3 Influence of AdaptivCRT algorithm (aCRT) programming and PR interval on incident atrial fibrillation (AF). The curves reflect unadjusted Kaplan-Meier estimates of cumulative incidence of developing 48 hours of AF among patients with aCRT-capable devices and a device-measured PR interval >200 ms (A) and measured PR interval ≤200 ms (B), stratified by programmed mode of biventricular (BiV) pacing (aCRT off, green lines; vs adaptive BiV pacing, red lines; vs adaptive BiV and LV pacing, purple lines) shown over 3 years of follow-up. Log rank test for each comparison, P < .001. Heart Rhythm 2019 16, 983-989DOI: (10.1016/j.hrthm.2019.05.012) Copyright © 2019 The Authors Terms and Conditions

Figure 4 Influence of percent left ventricular (LV)-only pacing and PR interval on incident atrial fibrillation (AF). Curves reflect unadjusted Kaplan-Meier estimates of cumulative incidence of developing 48 hours of AF among patients with AdaptivCRT algorithm (aCRT)-capable devices programmed to adaptive biventricular (BiV) and LV pacing and device-measured PR interval >200 ms (A) and measured PR interval ≤200 ms (B), stratified by increasing quartiles of LV-only pacing, with quartile 1 (0%–5% LV-only pacing; blue line); quartile 2 (5%–59% LV-only pacing; black line); quartile 3 (59%–92% LV-only pacing; green line); and quartile 4 (>92% LV-only pacing; purple line) shown over 3 years of follow-up. There is no purple line in A because, as expected, few patients with PR >200 ms had >92% LV-only pacing. Log rank test for each comparison, P < .001. Heart Rhythm 2019 16, 983-989DOI: (10.1016/j.hrthm.2019.05.012) Copyright © 2019 The Authors Terms and Conditions