Crossover RCT | Atrial pacing to increase exercise HR did not improve performance in HFpEF patients with chronotropic incompetence

Summary: The RAPID-HF randomized clinical trial investigated whether implanting and programming a pacemaker for rate-adaptive atrial pacing would improve exercise performance in patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence.

The study involved 29 patients with symptomatic HFpEF and chronotropic incompetence who underwent pacemaker implantation for the study and then were randomized to atrial rate responsive pacing or no pacing for four weeks, followed by a four-week washout period and then crossover for an additional four weeks.

The study found that atrial pacing increased early and peak exercise heart rate, but there was no improvement in exercise performance or quality of life. Despite a higher exercise heart rate, there was no increase in exercise cardiac output due to a decrease in stroke volume. Moreover, pacemaker implantation was associated with adverse events.

Article: Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction: The RAPID-HF Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Rate-Adaptive Pacing for Heart Failure With Preserved Ejection Fraction – JAMA (free for a limited period)

Commentaries:

RAPID-HF: Rate-Adaptive Pacing Doesn’t Help in HFpEF – TCTMD

Atrial Pacing for HFpEF Shows Lack of Benefit on Exercise Capacity – HCP Live

Commentary on Twitter

In patients with HFpEF and inadequate response of heart rate to exertion (chronotropic incompetence), implantation of a pacemaker to enhance exercise heart rate did not improve exercise capacity, symptoms, or exercise cardiac output. https://t.co/odBbeuuCPO #ACC23 #WCCardio

— JAMA (@JAMA_current) March 5, 2023