Personalized accelerated physiologic pacing

Markus Meyer, Margaret Infeld, Nicole Habel, Daniel Lustgarten

Research output: Contribution to journalArticlepeer-review

Abstract

Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent with a high socioeconomic burden. Pharmacological heart rate lowering was recommended to improve ventricular filling in HFpEF. This article discusses the misperceptions that have resulted in an overprescription of beta-blockers, which in all likelihood have untoward effects on patients with HFpEF, even if they have atrial fibrillation or coronary artery disease as a comorbidity. Directly contradicting the lower heart rate paradigm, faster heart rates provide haemodynamic and structural benefits, amongst which lower cardiac filling pressures and improved ventricular capacitance may be most important. Safe delivery of this therapeutic approach is feasible with atrial and ventricular conduction system pacing that aims to emulate or enhance cardiac excitation to maximize the haemodynamic benefits of accelerated pacing. This conceptual framework was first tested in the myPACE randomized controlled trial of patients with pre-existing pacemakers and preclinical or overt HFpEF. This article provides the background and path towards this treatment approach.

Original languageEnglish (US)
Pages (from-to)G33-G43
JournalEuropean Heart Journal, Supplement
Volume25
Issue numberSG
DOIs
StatePublished - Nov 1 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s).

Keywords

  • Cardiac filling pressures
  • Cardiac remodelling
  • Conduction system pacing
  • Diastolic function
  • Ejection fraction
  • Heart failure
  • Heart rate

PubMed: MeSH publication types

  • Journal Article

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