{"id":"da1ed4887e1f","type":"article","url":"https://hartvaat.nl/2023/03/01/gepersonaliseerde-versnelde-pacing-bij-hfpef-met-pacemaker/","title":"Gepersonaliseerde versnelde pacing bij HFpEF met pacemaker","title_en":"Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.5320","source_url":"https://doi.org/10.1001/jamacardio.2022.5320","authors":["Margaret Infeld","Kramer Wahlberg","Jillian Cicero","Timothy B Plante","Sean Meagher","Alexandra Novelli","Nicole Habel","Anand Muthu Krishnan","Daniel N Silverman","Martin M LeWinter","Daniel L Lustgarten","Markus Meyer"],"significance":7,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This trial investigated whether a personalized higher pacemaker backup rate improves symptoms and physical activity in HFpEF patients with pacemakers, exploring chronotropic optimization as a therapeutic strategy in this population.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Trial onderzocht of een hogere backup-hartfrequentie dan de standaard 60 spm de symptomen en fysieke activiteit verbetert bij HFpEF-patiënten met pacemaker. Versnelde pacing verbeterde de kwaliteit van leven en fysieke activiteit significant.","abstract_original":"IMPORTANCE: Patients with heart failure with preserved ejection fraction (HFpEF) with a pacemaker may benefit from a higher, more physiologic backup heart rate than the nominal 60 beats per minute (bpm) setting. OBJECTIVE: To assess the effects of a moderately accelerated personalized backup heart rate compared with 60 bpm (usual care) in patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony. DESIGN, SETTING, AND PARTICIPANTS: This blinded randomized clinical trial enrolled patients with stage B and C HFpEF from the University of Vermont Medical Center pacemaker clinic between June 2019 and November 2020. Analysis was modified intention to treat. INTERVENTIONS: Participants were randomly assigned to personalized accelerated pacing or usual care and were followed up for 1 year. The personalized accelerated pacing heart rate was calculated using a resting heart rate algorithm based on height and modified by ejection fraction. MAIN OUTCOMES AND MEASURES: The primary outcome was the serial change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score. Secondary end points were changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, pacemaker-detected physical activity, atrial fibrillation from baseline, and adverse clinical events. RESULTS: Overall, 107 participants were randomly assigned to the personalized accelerated pacing (n = 50) or usual care (n = 57) groups. The median (IQR) age was 75 (69-81) years, and 48 (48%) were female. Over 1-year follow-up, the median (IQR) pacemaker-detected heart rate was 75 (75-80) bpm in the personalized accelerated pacing arm and 65 (63-68) bpm in usual care. MLHFQ scores improved in the personalized accelerated pacing group (median [IQR] baseline MLHFQ score, 26 [8-45]; at 1 month, 15 [2-25]; at 1 year, 9 [4-21]; P < .001) and worsened with usual care (median [IQR] baseline MLHFQ score, 19 [6-42]; at 1 month, 23 [5-39]; at 1 year, 27 [7-52]; P = .03). In addition, personalized accelerated pacing led to improved changes in NT-proBNP levels (mean [SD] decrease of 109 [498] pg/dL vs increase of 128 [537] pg/dL with usual care; P = .02), activity levels (mean [SD], +47 [67] minutes per day vs -22 [35] minutes per day with usual care; P < .001), and device-detected atrial fibrillation (27% relative risk reduction compared with usual care; P = .04) over 1-year of follow-up. Adverse clinical events occurred in 4 patients in the personalized accelerated pacing group and 11 patients in usual care. CONCLUSIONS AND RELEVANCE: In this study, among patients with HFpEF and pacemakers, treatment with a moderately accelerated, personalized pacing rate was safe and improved quality of life, NT-proBNP levels, physical activity, and atrial fibrillation compared with the usual 60 bpm setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04721314."}