Small decreases in biventricular pacing percentages are associated with multiple metrics of worsening heart failure as measured from a cardiac resynchronization therapy defibrillator

•Deteriorating sensor trends, associated heart failure worsening, were found with small decrements in BiV percent pacing.•Patients in HeartLogic alert are more likely to have suboptimal BiV pacing.•The percent BiV pacing was reduced, and the HeartLogic index was increased, preceding heart failure hospitalizations.•These observations support the recommendation to maximize BiV percent pacing, to improve the heart failure condition.