1Department of Ophthalmology, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research
2Department of Oral Pathology, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research
3Meenakshi College of Arts and Science, Meenakshi Academy of Higher Education and Research
4Meenakshi College of Pharmacy, Meenakshi Academy of Higher Education and Research
5Meenakshi College of Physiotherapy, Meenakshi Academy of Higher Education and Research
6Meenakshi College of Allied Health Sciences, Meenakshi Academy of Higher Education and Research
Background: Heart failure that preserves ejection fraction (HFpEF) is associated with poor diastolic performance, decreased physical performance, and elevated patient-related symptoms leading to poor quality of life (QoL). AF and chronotropic incompetence are common comorbid conditions in HFpEF and also contribute towards the improved capacity of the heart. Personalized accelerated pacing (PAP) that changes the pacing rates in accordance to personal physiologic demand has been proposed as possibly useful in improving cardiac performance, advancing physical activity, and decreasing AF load but there is less evidence on the holistic effects of this on patient-centered outcomes.
Objective: There is a need to determine the effectiveness of individualized accelerated pacing on the quality of life, physical activity, and burden of atrial fibrillation in HFpEF patients.
Methods: This was a prospective, randomized, controlled trial that recruited HFpEF participants with either pacemaker or cardiac device capability of individually adjusting their rate. Individuals were randomly assigned to (1) PAP with profiles of individual chronotropic response programmed, or (2) guideline based pacing. The main outcomes were a change in the quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ] score) and daily physical activity (measured by accelerometer-monitored step counts and duration of activities) in 6 months. The secondary endpoints were AF burden (measured as device), NT-proBNP levels, 6-minute walk distance (6MWD), and the heart rate variability variables. The methods of analysis were intention-to-treat repeated-measures modeling.
Results: Follow up was done in 148 patients (mean age 72 ± 8 years; 61% female). PAP led to lower QoL with KCCQ overall summary score improving by 18 ± 6 points compared to 6 ± 4 points in controls (p < 0.001). Patients in PAP relative condition showed a 24 percentage improvement in daily physical activity, especially in the number of steps and length of time in moderate intensity, as well (p = 0.01). In the PAP group, the decrement of AF burden was 32 percent less than that of controls (no significant difference, p = 0.02). PAP was also preferred in terms of secondary outcomes such as the increase of the 6MWD (+45 m vs. +12 m, p < 0.05) and the decreasing levels of NT-proBNP (p = 0.04). Adverse events associated with devices were not noticed.
Conclusion: Individualized accelerated pacing appears to have exceptional contributions to quality of life, more physical activity and less burden of atrial fibrillation in patients with HFpEF. These results indicate that customized rate-sensitive pacing could be used to strengthen physiologic restraints within critical conditions in HFpEF and is a promising non-pharmacologic treatment methodology.
Keywords: HFpEF, Individualized pacing, faster pacing, chronotropic incompetence, atrial fibrillation, quality of life, physical activity, cardiac devices.
How to cite this article: Indhu C, Sindhu S, Devi PN, Sudhakar K, Kodi KM, Ramnath V. Efficacy of Personalized Accelerated Pacing on Quality of Life, Physical Activity and Atrial Fibrillation in HFpEF. Int J Drug Deliv Technol. 2026;16(10s): 138-144; DOI: 10.25258/ijddt.16.10s.20
Source of support: Nil.
Conflict of interest: None