Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;29(2):523-534.
doi: 10.1007/s10741-024-10382-1. Epub 2024 Jan 28.

Anti-bradycardia pacing-impact on patients with HFpEF: a systematic review

Alexandru Ababei #  1 , Luciana Andreea Hrib  1 , Adalia Cristiana Iancu  2 , Andra-Valeria Hadarag  1 , Ahmad Khebbaiz  1 , Radu Vătășescu  1   3 , Ștefan Bogdan  1   4
Affiliations

Anti-bradycardia pacing-impact on patients with HFpEF: a systematic review

Alexandru Ababei et al. Heart Fail Rev. 2024 Mar.

Abstract

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.

Keywords: Cardiac pacing; HFpEF; Heart rate; Left ventricular diastolic dysfunction; Pacemaker.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The relationship between HR and LVEDP at baseline (median: 66 bpm in HFpEF, 72 bpm in control), 100 bpm, and 120 bpm in patients with HFpEF and control [7]. Graphics program used: Microsoft Corporation. (2018). Microsoft Excel. Retrieved from https://office.microsoft.com/excel
Fig. 2
Fig. 2
PRISMA study selection flow diagram. Graphics program used: Microsoft Corporation. (2018). Microsoft Word. Retrieved from https://office.microsoft.com/word
Fig. 3
Fig. 3
Influence of the HR on pathophysiology of HFpEF patients a. During rest HR, LVEDP, and wall thickness are increased at any volume due to passive stiffness. b. Increased HR during rest, using a pacemaker, LVEDP decreases due to enhanced myocardial contraction and relaxation. c. During exercise, LVEDP increases because of higher HR along with SNS activation [, , –16]. HR, heart rate; LVEDP, left ventricular end-diastolic pressure; SNS, sympathetic nervous system. Graphics program used: Adobe Inc. (2019). Adobe Illustrator. Retrieved from https://adobe.com/products/illustrator
See this image and copyright information in PMC

References

    1. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, Böhm M, Butler J, Drazner MH, Michael Felker G, Filippatos G, Fiuzat M, Fonarow GC, Gomez-Mesa J-E, Heidenreich P, Imamura T, Jankowska EA, Januzzi J, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Francesco Piepoli M, Ponikowski P, Rosano GMC, Sakata Y, Seferović P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S (2021) Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 23:352–380. 10.1002/ejhf.2115 - PubMed
    1. Oktay AA, Rich JD, Shah SJ. The emerging epidemic of heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2013;10:401–410. doi: 10.1007/s11897-013-0155-7. - DOI - PMC - PubMed
    1. Nair N (2020) Epidemiology and pathogenesis of heart failure with preserved ejection fraction. Rev Cardiovasc Med 21:531–540. 10.31083/j.rcm.2020.04.154 - PubMed
    1. Aurigemma GP, Zile MR, Gaasch WH. Contractile behavior of the left ventricle in diastolic heart failure: with emphasis on regional systolic function. Circulation. 2006;113:296–304. doi: 10.1161/CIRCULATIONAHA.104.481465. - DOI - PubMed
    1. Silverman DN, Rambod M, Lustgarten DL, Lobel R, LeWinter MM, Meyer M. Heart rate-induced myocardial ca2+ retention and left ventricular volume loss in patients with heart failure with preserved ejection fraction. J Am Heart Assoc. 2020;9:e017215. doi: 10.1161/JAHA.120.017215. - DOI - PMC - PubMed

Publication types