We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
A new algorithm for optimization of rate‐adaptive pacing improves exercise tolerance in patients with HFpEF.
- Authors
Serova, Maria; Andreev, Denis; Giverts, Ilya; Sazonova, Yulia; Svet, Aleksey; Kuklina, Maria; Sedov, Vsevolod; Syrkin, Abram; Saner, Hugo
- Abstract
Aim: To develop an algorithm for optimization of rate‐adaptive pacing settings in heart failure patients with preserved ejection fraction (HFpEF) and permanent cardiac pacing. Methods: This is a prospective randomized controlled study. A total of 54 patients with HFpEF, permanent atrial fibrillation (AF), and VVIR pacing were randomized to an intervention group with optimization of rate‐adaptation parameters by using cardiopulmonary exercise testing (CPET) and pacemaker stress echocardiography (PASE), and to a control group with conventional programming. CPET, 6‐min walk test (6‐mwt), echocardiography (echo), Duke Activity Status Index (DASI), and Minnesota questionnaire (MLHFQ) were performed at baseline and after 3 months. PASE was used to exclude exercise‐induced ischemia and to determine safe upper sensor rate. Pacing parameters were corrected to achieve optimal heart rate increments of 3‐6 bpm for 1 mL/min/kg of VO2 (oxygen uptake). Results: After 3 months, the intervention group demonstrated significant improvement of VO2 peak by 1.64 ± 1.6 mL/min/kg, anaerobic threshold by 1.33 ± 1.3 mL/min/kg, exercise time by 170 ± 98 s, 6‐mwt distance by 75 ± 63 m (P <.0001 for all), DASI by 5.23 points (P =.009), MLHFQ‐score (reduction by 9 points, P <.0001), and echo parameters (decrease in LA volume from 108 (84; 132) to 95 (85; 130) mL, P =.026; E/e' from 11.7 ± 3.2 to 10.4 ± 2.9, P =.025; systolic pulmonary artery pressure (SPAP) from 44 ± 14 to 39 ± 12 mm Hg, P =.001) compared to the control group. Conclusion: An algorithm incorporating CPET and PASE for optimal programming of rate‐adaptation parameters is a valuable tool to improve exercise capacity in HFpEF patients with permanent AF and VVIR pacing who remain exercise intolerant after conventional programming.
- Subjects
ALGORITHMS; ATRIAL fibrillation; CARDIAC pacing; CARDIOPULMONARY system; ECHOCARDIOGRAPHY; EXERCISE tests; HEART failure; LONGITUDINAL method; QUESTIONNAIRES; STATISTICAL sampling; RANDOMIZED controlled trials; DESCRIPTIVE statistics; EXERCISE tolerance; VENTRICULAR ejection fraction
- Publication
Pacing & Clinical Electrophysiology, 2020, Vol 43, Issue 2, p223
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.13857