Optimal Cardiac Resynchronization Therapy Pacing Rate in Non-Ischemic Heart Failure Patients: A Randomized Crossover Pilot Trial.

Abstract

BACKGROUND:

The optimal pacing rate during cardiac resynchronization therapy (CRT) is unknown. Therefore, we investigated the impact of changing basal pacing frequencies on autonomic nerve function, cardiopulmonary exercise capacity and self-perceived quality of life (QoL).

METHODS:

Twelve CRT patients with non-ischemic heart failure (NYHA class II-III) were enrolled in a randomized, double-blind, crossover trial, in which the basal pacing rate was set at DDD-60 and DDD-80 for 3 months (DDD-R for 2 patients). At baseline, 3 months and 6 months, we assessed sympathetic nerve activity by microneurography (MSNA), peak oxygen consumption (pVO2), N-terminal pro-brain natriuretic peptide (p-NT-proBNP), echocardiography and QoL.

RESULTS:

DDD-80 pacing for 3 months increased the mean heart rate from 77.3 to 86.1 (p = 0.001) and reduced sympathetic activity compared to DDD-60 (51±14 bursts/100 cardiac cycles vs. 64±14 bursts/100 cardiac cycles, p<0.05). The mean pVO2 increased non-significantly from 15.6±6 mL/min/kg during DDD-60 to 16.7±6 mL/min/kg during DDD-80, and p-NT-proBNP remained unchanged. The QoL score indicated that DDD-60 was better tolerated.

CONCLUSION:

In CRT patients with non-ischemic heart failure, 3 months of DDD-80 pacing decreased sympathetic outflow (burst incidence only) compared to DDD-60 pacing. However, Qol scores were better during the lower pacing rate. Further and larger scale investigations are indicated.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02258061.

• Authors: Adam Ali Ghotbi, Mikael Sander, Lars Køber, Berit Th Philbert, Finn Gustafsson, Christoffer Hagemann, Andreas Kjær, Peter K Jacobsen
• Journal: PloS one (PLoS One) Vol. 10 Issue 9 Pg. e0138124 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 26382243 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Calibration
• Cardiac Resynchronization Therapy (adverse effects, methods, standards)
• Cross-Over Studies
• Double-Blind Method
• Exercise Tolerance (physiology)
• Female
• Heart Failure (blood, physiopathology, therapy)
• Heart Rate (physiology)
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Oxygen Consumption (physiology)
• Peptide Fragments (blood)
• Pilot Projects
• Quality of Life