Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction —Reply

In Reply The RAPID-HF study, which was the first randomized trial testing atrial pacing to increase exercise heart rate in patients with HFpEF, demonstrated no benefit in exercise performance, with a decrease in exercise stroke volume preventing gains in cardiac output. Dr Yamamoto speculates that atrial pacing might have been more effective for older patients because diastolic dysfunction worsens with aging. However, shortening of diastole with higher heart rate would be expected to be even more poorly tolerated in these patients. The devices were programmed based on hall walk and each participant ’s prior peak heart rate, not hall walk alone. Eligibility criteria required no evidence of heart block to ensure 100% atrial pacing during exercise and to avoid dyssynchronous ventricular pacing. This limits reprogramming of A-V intervals, which would be of unclear benefit regardless. We did not “overlook” the importance of heart rate—its importance was the motivation for this study.

Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research