Accelerated atrial pacing reduces left-heart filling pressure: a combined clinical-computational study.

IF 37.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal Pub Date : 2024-12-07 DOI:10.1093/eurheartj/ehae718

Tim van Loon, Jesse Rijks, Johan van Koll, Joey Wolffs, Richard Cornelussen, Nick van Osta, Justin Luermans, Frits Prinzen, Dominik Linz, Vanessa van Empel, Tammo Delhaas, Kevin Vernooy, Joost Lumens

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引用次数: 0

Abstract

Background and aims: Accelerated atrial pacing offers potential benefits for patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF), compared with standard lower-rate pacing. The study investigates the relationship between atrial pacing rate and left-heart filling pressure.

Methods: Seventy-five consecutive patients undergoing catheter ablation for AF underwent assessment of mean left atrial pressure (mLAP) and atrioventricular (AV) conduction delay (PR interval) in sinus rhythm and accelerated atrial pacing with 10 bpm increments up to Wenckebach block. Computer simulations (CircAdapt) of a virtual HFpEF cohort complemented clinical observations and hypothesized the modulating effects of AV coupling and atrial (dys)function.

Results: In the study cohort, 49(65%) patients had a high HFpEF likelihood (H2FPEF ≥ 5.0), and 28(37%) an elevated mLAP ≥ 15 mmHg at sinus rhythm. Optimal pacing rates of 100 [70-110]bpm (median [IQR]) significantly reduced mLAP from 12.8 [10.0-17.4]mmHg in sinus rhythm (55 [52-61]bpm) to 10.4 [7.8-14.8]mmHg (P < .001). Conversely, higher pacing rates (130 [110-140]bpm) significantly increased mLAP to 14.7 [11.0-17.8]mmHg (P < .05). PR interval and, hence, AV conduction delay prolonged incrementally with increasing pacing rates. Simulations corroborated these clinical findings, showing mLAP reduction at a moderately increased pacing rate and a subsequent increase at higher rates. Moreover, simulations suggested that mLAP reduction is optimized when AV conduction delay shortens with increasing rate.

Conclusions: Accelerated pacing acutely reduces left-heart filling pressure in patients undergoing AF catheter ablation and computer simulations with HFpEF features, suggesting it as a potential therapeutic strategy to alleviate congestion symptoms. Virtual HFpEF patient cohorts hypothesize that AV sequential pacing may further optimize this therapy's beneficial effects.

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加速心房起搏可降低左心充盈压：一项临床与计算相结合的研究。

背景和目的：与标准的低速率起搏相比，加速心房起搏为射血分数保留型心力衰竭（HFpEF）和心房颤动（AF）患者带来了潜在的益处。该研究调查了心房起搏率与左心充盈压之间的关系：方法：75 名连续接受房颤导管消融术的患者在窦性心律和加速心房起搏时接受了平均左心房压（mLAP）和房室（AV）传导延迟（PR 间期）评估，起搏速度以 10 bpm 为单位递增，直至 Wenckebach 阻滞。计算机模拟（CircAdapt）虚拟 HFpEF 队列补充了临床观察结果，并假设了房室耦合和心房（功能障碍）的调节作用：在研究队列中，49 名（65%）患者有较高的 HFpEF 可能性（H2FPEF ≥ 5.0），28 名（37%）患者在窦性心律时 mLAP 升高 ≥ 15 mmHg。最佳起搏频率为 100 [70-110]bpm （中位数 [IQR]），可显著降低 mLAP，从窦性心律时的 12.8 [10.0-17.4]mmHg （55 [52-61]bpm ）降至 10.4 [7.8-14.8]mmHg （P < .001）。相反，较高的起搏频率（130 [110-140]bpm ）会显著增加 mLAP 至 14.7 [11.0-17.8]mmHg （P < .05）。随着起搏频率的增加，PR 间期以及房室传导延迟逐渐延长。模拟结果证实了这些临床发现，显示起搏频率适度增加时 mLAP 会降低，而起搏频率提高时 mLAP 会增加。此外，模拟结果表明，当房室传导延迟随起搏频率增加而缩短时，mLAP 的降低达到最佳状态：结论：加速起搏可迅速降低房颤导管消融患者的左心充盈压和具有高频心衰特征的计算机模拟患者的左心充盈压，这表明加速起搏是缓解充血症状的一种潜在治疗策略。虚拟 HFpEF 患者队列假设，房室顺序起搏可进一步优化该疗法的有益效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.