Optimal Cardiac Resynchronization Therapy Pacing Rate in Non-Ischemic Heart Failure Patients: A Randomized Crossover Pilot Trial

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Adam Ali Ghotbi, Mikael Sander, Lars Køber, Berit Thornvig Philbert, Finn Gustafsson, Christoffer Hagemann, Andreas Kjær, Peter K Jacobsen

BACKGROUND: The optimal pacing rate during cardiac resynchronization therapy (CRT) is unknown. Therefore, we investigated the impact of changing basal pacing frequencies on autonomic nerve function, cardiopulmonary exercise capacity and self-perceived quality of life (QoL).

METHODS: Twelve CRT patients with non-ischemic heart failure (NYHA class II-III) were enrolled in a randomized, double-blind, crossover trial, in which the basal pacing rate was set at DDD-60 and DDD-80 for 3 months (DDD-R for 2 patients). At baseline, 3 months and 6 months, we assessed sympathetic nerve activity by microneurography (MSNA), peak oxygen consumption (pVO2), N-terminal pro-brain natriuretic peptide (p-NT-proBNP), echocardiography and QoL.

RESULTS: DDD-80 pacing for 3 months increased the mean heart rate from 77.3 to 86.1 (p = 0.001) and reduced sympathetic activity compared to DDD-60 (51±14 bursts/100 cardiac cycles vs. 64±14 bursts/100 cardiac cycles, p<0.05). The mean pVO2 increased non-significantly from 15.6±6 mL/min/kg during DDD-60 to 16.7±6 mL/min/kg during DDD-80, and p-NT-proBNP remained unchanged. The QoL score indicated that DDD-60 was better tolerated.

CONCLUSION: In CRT patients with non-ischemic heart failure, 3 months of DDD-80 pacing decreased sympathetic outflow (burst incidence only) compared to DDD-60 pacing. However, Qol scores were better during the lower pacing rate. Further and larger scale investigations are indicated.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02258061.

Original languageEnglish
Article numbere0138124
JournalP L o S One
Issue number9
Pages (from-to)1-17
Number of pages17
Publication statusPublished - 2015

    Research areas

  • Aged, Calibration, Cardiac Resynchronization Therapy, Cross-Over Studies, Double-Blind Method, Exercise Tolerance, Female, Heart Failure, Heart Rate, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Oxygen Consumption, Peptide Fragments, Pilot Projects, Quality of Life

ID: 162453019