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European Journal of Heart Failure 2009 11(1):53-57; doi:10.1093/eurjhf/hfn016
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Heart rate per se impacts cardiac function in patients with systolic heart failure and pacing: a pilot study

Damien Logeart1,2,*, Jean-Pierre Gueffet3, François Rouzet4, Françoise Pousset5, Christophe Chavelas1, Alain Cohen Solal1,2,6 and Guillaume Jondeau6,7

1 Hôpital Lariboisière, Cardiology Department, Assistance Publique – Hôpitaux de Paris, Paris, France
2 INSERM U942, Paris, France
3 Centre Hospitalo-Universitaire Hotel-Dieu, Cardiology Department, Nantes, France
4 Groupe Hospitalier Bichat – Claude Bernard, Nuclear Medicine Department, Assistance Publique – Hôpitaux de Paris, France
5 Groupe Hospitalier Pitié Salpétrière, Cardiology Department, Assistance Publique - Hôpitaux de Paris, Paris, France
6 University Paris Diderot, Paris, France
7 Groupe Hospitalier Bichat – Claude Bernard, Cardiology Department, Paris, France

* Corresponding author. Cardiology Department, Lariboisière Hospital, 2 rue Ambroise Paré, 75010 Paris. Tel: +33 149956608, Fax: +33 149958439, Email: damien.logeart{at}lrb.aphp.fr.


  Abstract

Aims: This study was designed to compare the specific effects of two heart rates (HR), 55 and 75 b.p.m., in patients with heart failure (HF).

Methods and results: Patients with chronic HF, left ventricular ejection fraction (LVEF) ≤ 35%, and a pacemaker with >90% of paced QRS, were included in a randomized cross-over trial of two 3-month periods where pacing rate was set at either 55 or 75 b.p.m. At the end of each period, patients were examined and radionuclide ventriculography, echocardiography, and blood sampling were performed for centralized and blinded analysis. Two patients did not complete the study because of early worsening while paced at 75 b.p.m. Twelve patients completed the study. Compared with 75 b.p.m., pacing at 55 b.p.m. was associated with a higher LVEF [+4.7% (2.6–6.7), P < 0.001], lower B-type natriuretic peptide levels [–91 pg/mL (–148 to –33), P < 0.01], lower systolic pulmonary artery pressure (41 ± 10 vs. 47 ± 10 mmHg, P = 0.02) and lower NYHA (New York Heart Association) class (2.2 ± 0.6 vs. 2.6 ± 0.5, P = 0.03). The baseline pacing rate prior to inclusion had no effect on results.

Conclusion: HR per se may impact cardiac function and low HR might be beneficial in patients with systolic HF compared with intermediate HR.

Key Words: Heart rate • Pacing • Heart failure • Ventricular function

Received April 20, 2008; Revised September 11, 2008; Accepted November 3, 2008


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