Rate-adaptive pacing in right-sided heart failure with tricuspid regurgitation: A prospective pilot study

Heart rate (HR) needs to be controlled at a lower level for patients with left ventricular systolic heart failure, but the appropriate HR for patients with right-sided heart failure (RHF) is still unclear. This study aims to test whether increasing HR in patients with RHF and severe tricuspid regurgitation (TR) could improve hemodynamics and quality of life.

Patients with severe TR, RHF symptoms, and dependency on permanent pacemakers were enrolled. The pacing rate was adjusted to 90 bpm from <70 bpm. The right-sided heart hemodynamics before and after the HR acceleration, the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, the New York Heart Association (NYHA) class, edema degree, 6-min walk distance (6MWD), and echocardiography data were recorded at baseline, 1-month, and 3-month follow-ups.

Ten patients were enrolled with an average age of 75.6 ± 10.0 years. After HR acceleration, the vena cava and right atrial pressure were decreased by 2-4 mmHg (all P<0.05). Cardiac output increased from 3.2 ± 0.9 L/min to 4.1 ± 1.6 L/ min (mean difference: -0.96, 95 % CI: [0.30, 1.62], P = 0.009). At the 3-month follow-up, the edema degree (0.4 ± 0.7 vs 1.4 ± 0.9, P < 0.01), KCCQ scores (75.1 ± 10.3 vs 50.9 ± 14.8), NYHA class (2.2 ± 0.9 vs 2.9 ± 1.0), and 6MWD (315.6 ± 59.1 m vs 205.1 ± 65.9 m) were significantly improved (all P < 0.01).

Increasing HR can improve right-sided heart hemodynamics and quality of life in patients with RHF and severe TR, which may be a novel, simple, and effective method to treat patients with RHF and severe TR who are dependent on permanent pacemakers.