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Europace Advance Access originally published online on August 21, 2008
Europace 2008 10(10):1182-1188; doi:10.1093/europace/eun213
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Pacing

Rate-responsive pacing in patients with heart failure: long-term results of a randomized study

Herbert Nägele1,*, Wilfried Rödiger2 and Maria Angeles Castel3

1 Medical Department, Hamburger Str. 41, St Adolfstift, Reinbek D-21465, Germany; 2 University Heart Center, Wördemanns Weg 25-27, 22527 Hamburg, Germany; 3 Hospital Clinic, Thorax Institute, Villarroel 170, 08036 Barcelona, Spain

Aims: Chronotropic incompetence (CI) in patients with congestive heart failure (CHF) develops frequently under β-blocker and amiodarone therapy. It can be corrected by pacing. We performed a randomized study to test whether pacing is beneficial in CHF patients with CI.

Methods and results: Congestive heart failure patients under combined beta-blocker and amiodarone therapy (n = 77) were randomly assigned to inhibited pacing (INH; basal rate 40 bpm/hysteresis 30 bpm; n = 38) or to DDDR pacing with optimized atrioventricular delay (OPT; stimulation rate 65–120 bpm, n = 39). Groups showed similar baseline values in NYHA class, heart rate, and ejection fraction (EF) and were followed up to 10 years. The resting and mean 24 h heart rate after 1 year decreased by –2.6/–5 bpm in INH, but increased by +3.6/+6.0 bpm in the OPT group (P < 0.001). The QRS interval after 1 year increased by 12 ± 23 ms in the INH group, but +32 ± 36 ms in the OPT group (P < 0.01). Patients with INH developed a greater left ventricular EF (LVEF) when compared with OPT patients (+10.6 ± 8 vs. +2 ± 10%, respectively; P = 0.04). Changes in LVEF were negatively correlated with heart rate, but not with QRS width changes. Prognosis and the event rate were better in the INH group.

Conclusion: In the long-term follow-up, single-site ventricular pacing in patients with CHF and low LVEF is associated with significant clinical events and a poor prognosis.

Key Words: Rate adaptive pacing, Heart failure, Heart rate, Atrioventricular delay

* Corresponding author. Tel: +49 40 7280 5158; fax: +49 40 7280 2729. E-mail address: herbert.naegele{at}krankenhaus-reinbek.de

Manuscript submitted 13 May 2008. Accepted after revision 25 July 2008.


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