BS-400-33 PERSONALIZED PACING (MYPACE): A NEW PARADIGM FOR PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract

Pacemaker patients with preclinical or overt heart failure with preserved ejection fraction (HFpEF) may benefit from a backup heart rate (HR) that is higher than the standard 60 beats per minute (bpm) setting. Assess the effects of a personalized backup HR (myPACE group, based on a HR algorithm) compared with 60bpm (control group). In this double blind randomized controlled study, pacemaker patients with HFpEF and either atrial pacing alone or conduction system or biventricular pacing were assigned to the myPACE or control group for 1 year. The primary outcome was change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (range 0-125, lower is better). Secondary outcomes were changes in N-terminal brain natriuretic peptide (NTproBNP), pacemaker-detected activity levels, pacemaker-detected atrial fibrillation (AF) burden, and adverse clinical events (composite of death, stroke, AF, and HF events). The myPACE (n=50; mean ± standard deviation age 76±12 years, 47% female) and control groups (n=57, mean age 75 ± 9 years, 48% female) were similar at baseline. The mean HR in the myPACE group was 77 ± 5bpm. Compared with controls, MLHFQ scores improved in the myPACE group over 1 year as shown in the Table (p<0.001). Similarly, NTproBNP levels and patient activity levels improved in the myPACE group (both p<0.02). The myPACE group had 6 adverse events in 6 patients and the control group had 19 adverse events in 14 patients. Among pacemaker patients with preclinical or overt HFpEF a moderately increased, personalized backup HR setting improves quality of life, NTproBNP, and activity levels compared with the standard 60bpm setting, without an excess of adverse effects.