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A Pacing-Controlled Procedure for the Assessment of Heart Rate-Dependent Diastolic Functions in Murine Heart Failure Models
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The effect of altering heart rate on ventricular function in patients with heart failure treated with beta-blockers

Simon D R Thackray1, Justin M Ghosh, Graham A Wright

  • 1Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom. simonthackray@hotmail.com

American Heart Journal
|September 26, 2006
PubMed

Insights

Beta-blocker therapy for heart failure may work by slowing heart rate. Increasing heart rate in pacemaker patients on beta-blockers worsened heart function, suggesting rate reduction is key.

Area of Science:

  • Cardiology
  • Pharmacology
  • Biomedical Engineering

Background:

  • Beta-blockers are established heart failure treatments, but their precise mechanism of action remains unclear.
  • Heart rate reduction, a common effect of beta-blockers, is debated as either a therapeutic mechanism or a side effect.

Purpose of the Study:

  • To investigate the role of heart rate reduction in the efficacy of beta-blocker treatment for heart failure.
  • To compare the effects of higher-rate versus lower-rate pacing on left ventricular (LV) remodeling in pacemaker-dependent patients receiving beta-blockers.

Main Methods:

  • A randomized, double-blind, parallel-group study was conducted.
  • Patients with symptomatic LV systolic dysfunction on beta-blockers underwent chronic pacing at 80 bpm (higher-rate) or 60 bpm (lower-rate).
  • Gated radionuclide ventriculography assessed LV volumes and ejection fraction at baseline and after 9 months.

Main Results:

  • Higher-rate pacing led to significant increases in LV end-diastolic and systolic volumes compared to lower-rate pacing.
  • LV ejection fraction declined with higher-rate pacing but improved slightly with lower-rate pacing.
  • A significant proportion of patients (43%) died during follow-up, highlighting poor prognosis.

Conclusions:

  • Reversing beta-blocker-induced bradycardia by increasing pacing rate has detrimental effects on ventricular function.
  • These findings suggest that heart rate reduction is a crucial mediator of beta-blockers' beneficial effects in heart failure.
  • Patients with pacemakers and heart failure exhibit a poor prognosis, underscoring the need for effective management strategies.
Abstract

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