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Open Access 28-01-2024 | Pacemaker

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

Authors: Alexandru Ababei, Luciana Andreea Hrib, Adalia Cristiana Iancu, Andra-Valeria Hadarag, Ahmad Khebbaiz, Radu Vătășescu, Ștefan Bogdan

Published in: Heart Failure Reviews | Issue 2/2024

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.

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Title: Anti-bradycardia pacing—impact on patients with HFpEF: a systematic review
Authors: Alexandru Ababei
Luciana Andreea Hrib
Adalia Cristiana Iancu
Andra-Valeria Hadarag
Ahmad Khebbaiz
Radu Vătășescu
Ștefan Bogdan
Publication date: 28-01-2024
Publisher: Springer US
Keywords: Pacemaker
Pacemaker
Pacemaker
Heart Failure
Published in: Heart Failure Reviews / Issue 2/2024
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-024-10382-1

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