A new algorithm for optimization of rate-adaptive pacing improves exercise tolerance in patients with HFpEF.
Pacing Clin Electrophysiol
; 43(2): 223-233, 2020 02.
Article
en En
| MEDLINE
| ID: mdl-31876292
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.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Algoritmos
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Estimulación Cardíaca Artificial
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Tolerancia al Ejercicio
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Insuficiencia Cardíaca
Tipo de estudio:
Clinical_trials
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Observational_studies
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Prognostic_studies
Límite:
Aged
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Female
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Humans
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Male
Idioma:
En
Año:
2020
Tipo del documento:
Article