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Updated: Jul 2, 2026
A Pacing-Controlled Procedure for the Assessment of Heart Rate-Dependent Diastolic Functions in Murine Heart Failure Models
Published on: July 21, 2023
Rate-responsive pacing in patients with heart failure: long-term results of a randomized study
Herbert Nägele1, Wilfried Rödiger, Maria Angeles Castel
1Medical Department, Hamburger Str. 41, St Adolfstift, Reinbek D-21465, Germany. herbert.naegele@krankenhaus-reinbek.de
Insights
Pacing strategies impact outcomes in congestive heart failure patients with chronotropic incompetence. Inhibited pacing improved left ventricular ejection fraction and prognosis compared to optimized DDDR pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Chronotropic incompetence (CI) is common in congestive heart failure (CHF) patients on beta-blocker and amiodarone therapy.
- Pacing can potentially correct CI, but its benefit in CHF patients requires investigation.
Purpose of the Study:
- To evaluate the efficacy of pacing in managing chronotropic incompetence in patients with congestive heart failure.
- To compare inhibited pacing (INH) versus optimized DDDR pacing (OPT) in CHF patients with CI.
Main Methods:
- A randomized study involving 77 CHF patients with CI on beta-blocker and amiodarone therapy.
- Patients were assigned to either INH pacing (basal rate 40 bpm/hysteresis 30 bpm) or OPT pacing (65-120 bpm).
- Follow-up extended up to 10 years, assessing heart rate, QRS interval, left ventricular ejection fraction (LVEF), and clinical events.
Main Results:
- The INH group showed a decrease in resting and mean 24h heart rate, while the OPT group showed an increase (P < 0.001).
- QRS interval increased more in the OPT group (P < 0.01).
- Patients in the INH group demonstrated a significantly greater improvement in LVEF compared to the OPT group (P = 0.04), with better prognosis and lower event rates.
Conclusions:
- Single-site ventricular pacing in CHF patients with low LVEF is associated with significant clinical events and poor long-term prognosis.
- Inhibited pacing appears to be a more beneficial strategy than optimized DDDR pacing for managing CI in this patient population.
Aims:
Chronotropic incompetence (CI) in patients with congestive heart failure (CHF) develops frequently under beta-blocker and amiodarone therapy. It can be corrected by pacing. We performed a randomized study to test whether pacing is beneficial in CHF patients with CI.
Methods And Results:
Congestive heart failure patients under combined beta-blocker and amiodarone therapy (n = 77) were randomly assigned to inhibited pacing (INH; basal rate 40 bpm/hysteresis 30 bpm; n = 38) or to DDDR pacing with optimized atrioventricular delay (OPT; stimulation rate 65-120 bpm, n = 39). Groups showed similar baseline values in NYHA class, heart rate, and ejection fraction (EF) and were followed up to 10 years. The resting and mean 24 h heart rate after 1 year decreased by -2.6/-5 bpm in INH, but increased by +3.6/+6.0 bpm in the OPT group (P < 0.001). The QRS interval after 1 year increased by 12 +/- 23 ms in the INH group, but +32 +/- 36 ms in the OPT group (P < 0.01). Patients with INH developed a greater left ventricular EF (LVEF) when compared with OPT patients (+10.6 +/- 8 vs. +2 +/- 10%, respectively; P = 0.04). Changes in LVEF were negatively correlated with heart rate, but not with QRS width changes. Prognosis and the event rate were better in the INH group.
Conclusion:
In the long-term follow-up, single-site ventricular pacing in patients with CHF and low LVEF is associated with significant clinical events and a poor prognosis.
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