Personalized accelerated physiologic pacing.
Cardiac filling pressures
Cardiac remodelling
Conduction system pacing
Diastolic function
Ejection fraction
Heart failure
Heart rate
Journal
European heart journal supplements : journal of the European Society of Cardiology
ISSN: 1520-765X
Titre abrégé: Eur Heart J Suppl
Pays: England
ID NLM: 100886647
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
medline:
16
11
2023
pubmed:
16
11
2023
entrez:
16
11
2023
Statut:
epublish
Résumé
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent with a high socioeconomic burden. Pharmacological heart rate lowering was recommended to improve ventricular filling in HFpEF. This article discusses the misperceptions that have resulted in an overprescription of beta-blockers, which in all likelihood have untoward effects on patients with HFpEF, even if they have atrial fibrillation or coronary artery disease as a comorbidity. Directly contradicting the lower heart rate paradigm, faster heart rates provide haemodynamic and structural benefits, amongst which lower cardiac filling pressures and improved ventricular capacitance may be most important. Safe delivery of this therapeutic approach is feasible with atrial and ventricular conduction system pacing that aims to emulate or enhance cardiac excitation to maximize the haemodynamic benefits of accelerated pacing. This conceptual framework was first tested in the myPACE randomized controlled trial of patients with pre-existing pacemakers and preclinical or overt HFpEF. This article provides the background and path towards this treatment approach.
Identifiants
pubmed: 37970518
doi: 10.1093/eurheartjsupp/suad117
pii: suad117
pmc: PMC10637836
doi:
Types de publication
Journal Article
Langues
eng
Pagination
G33-G43Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: M.M. and the University of Vermont have licensed patents for the use of pacemakers for the prevention and treatment of heart failure with preserved ejection fraction.
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