{"id":"32eccc06eb02","type":"article","url":"https://hartvaat.nl/2026/02/03/adaptieve-bloeddrukgemoduleerde-atriale-pacing-bij-hypertensief-hfpef-eerste-rct/","title":"Adaptieve bloeddrukgemoduleerde atriale pacing bij hypertensief HFpEF: eerste RCT","title_en":"Adaptive blood pressure-modulated atrial pacing in hypertensive HFpEF patients: a randomized, first-in-human study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","cardiale-resynchronisatie","hfpef","hfref","step-hfpef","summit-trial","supraventriculaire-tachycardie"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvaf020","source_url":"https://doi.org/10.1093/eschf/xvaf020","authors":["Michael H Burnam","Santosh Kumar Sinha","Mukesh Jitendra Jha","Sanjay Kumar Sharma","Amitesh Nagarwal","Rohit Chopra","Eli S Gang"],"significance":6,"published":"2026-02-03","source_date":"2026-02-03","image":"","kennis":[],"congress":"","summary_en":"This first-in-human randomized trial of adaptive blood pressure-modulated atrial pacing in hypertensive HFpEF tested an innovative device concept that links pacemaker rate response to real-time blood pressure feedback.","created":"2026-07-03T10:32:10Z","updated":"2026-07-03T18:39:20Z","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":"Eerste gerandomiseerde trial van adaptieve bloeddrukgemoduleerde pacing bij hypertensief HFpEF. Het innovatieve concept koppelt hartstimulatie aan hemodynamische behoeften.","abstract_original":"INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) represents approximately 50% of all heart failure cases and lacks effective treatments. Chronotropic incompetence contributes to exercise intolerance in these patients. This study evaluated the safety and efficacy of blood pressure-adaptive atrial pacing (BPAP) vs standard bradycardia pacing (STD) in hypertensive patients with HFpEF. METHODS: In this prospective, double-blind, randomized, self-controlled crossover study, 16 patients (mean age: 62.7 ± 10.9 years; 6% female; left ventricular ejection fraction 55.3 ± 3.8%) with treated hypertension and implanted dual-chamber pacemakers underwent two 3-week treatment phases (BPAP and STD) in random order. The BPAP algorithm-modulated atrial pacing rate in response to home blood pressure readings. Endpoints included the Minnesota Living With Heart Failure (MLWHF) score, New York Heart Association (NYHA) class, 6-minute walk test (6MWT), and modified Bruce treadmill test. RESULTS: BPAP improved MLWHF score by an additional 15% from baseline (P = .0288), whereas STD showed a non-significant 3% worsening. Exercise time increased significantly during BPAP (+83.2 ± 55.6 s, P = .005) but not during STD (+70.8 ± 84.4 s, P = .095). The 6MWT distance rose by 35.8 ± 29.9 m during BPAP (P = .003) vs minimal change with STD (+8.2 ± 40.1 m, P = .6). NYHA class improved in 55.6% of BPAP patients vs 11% with STD (P = .0455). Mean heart rate was higher during BPAP (83.8 ± 8.3 bpm) than STD (72.9 ± 12.0 bpm, P < .0001), with no difference in systolic blood pressure (137.5 ± 14.9 vs 138.6 ± 14.0 mmHg, P = .68). No adverse events occurred. CONCLUSION: In hypertensive patients with HFpEF and implanted pacemakers, BPAP safely improved exercise capacity and functional status compared to standard pacing. The approach demonstrates feasibility of home-based blood pressure-modulated pacing for physiologic rate adaptation. (NCT06036186)."}