Feasibility of physiological pacing rate in cardiac resynchronization therapy

• Published in: ESC Heart Failure Vol. 10; no. 4; pp. 2751 - 2753
• Main Authors: Spaggiari, Caio V., Siqueira, Sergio F., Oliveira, Camila Parente, Guiarão Gomes, Cinthya I., Alves, Maria Janieire de N. N., Filho, Martino Martinelli
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2023; John Wiley and Sons Inc; Wiley
• Subjects: Blood pressure; Body mass index; Cardiac Resynchronization Therapy; Cardiomyopathy; Ejection fraction; Feasibility Studies; Heart failure; Heart Failure - therapy; Heart rate; Humans; Pacemakers; Physiology; Short Communication; Short Communications; Treatment Outcome; Walk Test; Walking; Heart failure; Heart rate; Cardiac resynchronization therapy
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.14429

Aims Although cardiac resynchronization therapy (CRT) improves functional capacity in heart failure patients, a blunted heart rate (HR) response remains after treatment. So we aimed to evaluate the feasibility of the physiological pacing rate (PPR) in CRT patients. Methods A cohort of 30 clinical mildly symptomatic CRT patients underwent the six‐minute walk test (6MWT). During the 6MWT, HR, blood pressure, and maximum walking distance were assessed. The measurements were obtained in a pre to post manner, with CRT at nominal settings and with the physiological phase (CRT PPR), in which HR was increased by 10% above the maximum HR achieved previously. The CRT cohort also comprised a matched control group (CRT CG). In the CRT CG, the 6MWT was repeated after the standard evaluation with no PPR. The evaluations were blinded for patients and for the 6MWT evaluator. Results During the 6MWT, CRT PPR led to an increase in walking distance of 40.5 m (9.2%; P < 0.0001) when compared with baseline trial. Additionally, CRT PPR increased the maximum walking distance compared with CRT CG 479.3 ± 68.9 m vs. 420.3 ± 44.8 m, respectively, P = 0.001. In the CRT CG, CRT PPR increased the variation in walking distance, compared with baseline trials, respectively 2.40 ± 3.8% vs. 9.25 ± 7.0%, P = 0.007. Conclusions In mildly symptomatic CRT patients PPR is feasible, leading to improvements in functional capacity. In this regard, the efficacy of PPR must be confirmed by controlled randomized trials.