Hemodynamic and Functional Outcomes of Rate-Adaptive and Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.
- 1Department of Cardiology and Vascular Medicine Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar Bali Indonesia.
- 2Clinical Clerkship Program, Faculty of Medicine Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah Central General Hospital Denpasar Bali Indonesia.
Abstract
Background
Exercise intolerance and poor quality of life remain challenges in HFpEF, driven by chronotropic incompetence and left atrial dysfunction. We evaluated whether rate-adaptive/accelerated pacing (RAAP), targeting these mechanisms, improves hemodynamic, functional, and patient-reported outcomes.Methods
PubMed, Embase, and the Cochrane Library were searched. Outcomes included NT-proBNP, Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, 6-min walk distance (6MWD), E/e', and E/A. Within-group pre-post changes and comparisons with usual care were synthesized separately. Effects are reported as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).Results
Eight reports involving 380 patients were included with myPACE overlap handled by one report per cohort per analysis. Within-group, RAAP was associated with reductions in NT-proBNP (MD -462.58 pg/mL; 95% CI -891.37 to -33.79), E/A (MD -1.01; -1.19 to -0.83), and E/e' (MD -3.18; -5.65 to -0.72), and improvements in 6MWD (MD +74.10 m; 36.34 to 111.86) and MLHFQ score (MD -17.40 points; -33.06 to -1.74). Compared with usual care, associations favored RAAP for NT-proBNP (MD -108.51 pg/mL; -118.31 to -98.70), 6MWD (MD +73.36 m; 32.23 to 114.48), MLHFQ score (MD -16.52 points; -24.15 to -8.89), and AF burden (MD -6.13; -7.88 to -4.37). MACE also favored RAAP in an exploratory analysis (OR 0.47; 0.23 to 0.93), whereas peak VO₂ did not differ significantly.Conclusions
RAAP was associated with favorable changes in hemodynamic and functional outcomes. These findings support further evaluation of individualized rate modulation in adequately powered randomized trials.
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BibTeX
@article{jagannatha2026hemodynamic,
title = {{Hemodynamic and Functional Outcomes of Rate-Adaptive and Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.}},
author = {Gusti Ngurah Prana Jagannatha and David Yobel and Christo Timothy Mamangdean and Bagus Made Indrata Saputra and Anak Agung Ayu Dwi Adelia Yasmin and I Nyoman Wiryawan and I Made Putra Swi Antara},
journal = {Journal of arrhythmia},
year = {2026},
month = oct,
doi = {10.1002/joa3.70504},
url = {https://europepmc.org/article/MED/42927126},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hemodynamic and Functional Outcomes of Rate-Adaptive and Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.
AU - Gusti Ngurah Prana Jagannatha
AU - David Yobel
AU - Christo Timothy Mamangdean
AU - Bagus Made Indrata Saputra
AU - Anak Agung Ayu Dwi Adelia Yasmin
AU - I Nyoman Wiryawan
AU - I Made Putra Swi Antara
PY - 2026
DA - 2026/10/23
JO - Journal of arrhythmia
DO - 10.1002/joa3.70504
UR - https://europepmc.org/article/MED/42927126
AB - Background Exercise intolerance and poor quality of life remain challenges in HFpEF, driven by chronotropic incompetence and left atrial dysfunction. We evaluated whether rate-adaptive/accelerated pacing (RAAP), targeting these mechanisms, improves hemodynamic, functional, and patient-reported outcomes.Methods PubMed, Embase, and the Cochrane Library were searched. Outcomes included NT-proBNP, Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, 6-min walk distance (6MWD), E/e', and E/A. Within-group pre-post changes and comparisons with usual care were synthesized separately. Effects are reported as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).Results Eight reports involving 380 patients were included with myPACE overlap handled by one report per cohort per analysis. Within-group, RAAP was associated with reductions in NT-proBNP (MD -462.58 pg/mL; 95% CI -891.37 to -33.79), E/A (MD -1.01; -1.19 to -0.83), and E/e' (MD -3.18; -5.65 to -0.72), and improvements in 6MWD (MD +74.10 m; 36.34 to 111.86) and MLHFQ score (MD -17.40 points; -33.06 to -1.74). Compared with usual care, associations favored RAAP for NT-proBNP (MD -108.51 pg/mL; -118.31 to -98.70), 6MWD (MD +73.36 m; 32.23 to 114.48), MLHFQ score (MD -16.52 points; -24.15 to -8.89), and AF burden (MD -6.13; -7.88 to -4.37). MACE also favored RAAP in an exploratory analysis (OR 0.47; 0.23 to 0.93), whereas peak VO₂ did not differ significantly.Conclusions RAAP was associated with favorable changes in hemodynamic and functional outcomes. These findings support further evaluation of individualized rate modulation in adequately powered randomized trials.
SN - 1880-4276
SN - 1883-2148
ER -