Key result
Anti-bradycardia pacing at higher resting rates improves HFpEF symptoms, but higher exertional rates lack benefit.
Why the study?
The protective effect of bradycardia seen in patients with reduced ejection fraction using beta-blockers or ivabradine does not improve symptoms in HFpEF.
Does anti-bradycardia pacing improve functional status and quality of life in patients with HFpEF?
Systematic Review (n=219)
Does anti-bradycardia pacing improve functional status and quality of life in patients with HFpEF?
A higher resting heart rate achieved by atrial pacing may improve symptoms and quality of life in patients with HFpEF, whereas rate-adaptive pacing during exertion does not appear beneficial.
Higher resting-rate pacing may ease HFpEF symptoms now; extends sparse RCT data while challenging rate-adaptive strategies.
Heart failure with preserved ejection fraction (HFpEF) has become an emerging concern. The protective effect of bradycardia in patients with reduced ejection fraction using beta-blockers or ivabradine does not improve symptoms in HFpEF. This review aims to assess current data regarding the impact of anti-bradycardia pacing in patients with HFpEF. A search was conducted on PubMed, ScienceDirect, Springer, and Wiley Online Library, selecting studies from 2013 to 2023. Relevant and eligible prospective studies and randomized controlled trials were included. Functional status, quality of life, and echocardiographic parameters were assessed. Six studies conformed to the selection criteria. Four were prospective studies with a total of 90 patients analyzed. Two were randomized controlled trials with a total of 129 patients assessed. The 6-min walk test (6MWT) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score improved in all prospective studies. My-PACE trial showed improvements in MLHFQ score (p < 0.001), significant relative lowering in NT-proBNP levels (p = 0.02), and an increased mean daily activity in the personalized accelerated pacing group compared to usual care. RAPID-HF trial proved that pacemaker implantation to enhance exercise heart rate (HR) did not improve exercise capacity and was associated with increased adverse events. HFpEF requires a more individualized approach and quality of life management. This review demonstrates that higher resting HR by atrial pacing may improve symptoms and even outcomes in HFpEF, while a higher adaptive rate during exertion has not been proven beneficial.
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Ababei et al. (2024) conducted a systematic review in Heart failure with preserved ejection fraction (HFpEF) (n=219). Anti-bradycardia pacing (higher resting heart rate) vs. Usual care or lower heart rate setting was evaluated on Functional status, quality of life, and echocardiographic parameters. Anti-bradycardia pacing with a higher resting heart rate improved symptoms and quality of life in patients with HFpEF, while a higher adaptive rate during exertion was not beneficial.
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