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Rate-Response Programming Tailored to the Force-Frequency Relationship Improves Exercise Tolerance in Chronic Heart
John Gierula1, Maria F Paton1, Judith E Lowry1
1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
JACC. Heart Failure
|December 12, 2017
Summary
Tailoring pacemaker settings based on the force-frequency relationship (FFR) in chronic heart failure (CHF) patients improves exercise capacity. This personalized approach enhances exercise time and peak oxygen consumption, benefiting patients with pacemakers.
Area of Science:
- Cardiology
- Biomedical Engineering
- Exercise Physiology
Background:
- Chronic heart failure (CHF) is associated with a blunted force-frequency relationship (FFR), impacting the heart's ability to increase contractility with heart rate.
- The FFR describes the relationship between heart rate (HR) and myocardial contractility, which is often impaired in CHF patients.
Purpose of the Study:
- To investigate if the critical heart rate (HR) where the FFR slope peaks can guide pacemaker programming in CHF patients.
- To determine if this tailored HR programming improves exercise capacity in CHF patients with pacemakers.
Main Methods:
- An observational study assessed FFR characteristics (critical HR, peak contractility, FFR slope) in CHF patients and healthy controls using noninvasive echocardiography.
- A double-blind, randomized, controlled crossover study compared tailored FFR-based pacemaker programming with conventional programming in CHF patients.
Main Results:
- CHF patients exhibited lower critical HR, peak contractility, and FFR slope compared to controls.
- Tailored pacemaker programming, limiting HR rise below the critical HR, significantly increased exercise time and peak oxygen consumption in CHF patients.
Conclusions:
- Personalized pacemaker rate-response programming, guided by noninvasive FFR assessment, enhances exercise performance in CHF patients.
- This approach offers a reproducible method to optimize HR management and improve quality of life for CHF patients with pacemakers.
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