Finding the Best Pacing Rate for Heart Therapy in Patients with Persistent Atrial Fibrillation and Heart Failure

What this Trial Is About

Researchers are studying how different pacing rates affect exercise tolerance in patients with persistent atrial fibrillation AF and heart failure with preserved ejection fraction HFpEF who have undergone cardiac resynchronization therapy CRT after atrioventricular node AVN ablation. This study aims to find out if setting a pacing rate at 80 beats per minute bpm improves exercise capacity compared to 60 bpm. The study is a prospective, randomized crossover trial comparing these two pacing rates over time. Participants will be randomly divided into two groups one group will start with a pacing rate of 60 bpm for 3 months, then switch to 80 bpm for the next 3 months the other group will start with 80 bpm for 3 months, then switch to 60 bpm. The study will monitor patient mortality, heart failure hospitalizations, and various health measures at each phase. Treatments involve device-based pacing adjustments, and no placebo is used. During the study, participants will undergo assessments including electrocardiograms, echocardiograms, pacemaker checks, blood tests for BNP and creatinine, and questionnaires on quality of life and physical activity. The main outcome measure is exercise tolerance evaluated by the six-minute walk test at 3 months. Secondary measures include heart failure symptoms, atrial fibrillation burden, hospitalizations, and mortality related to heart and vascular events. The total study duration per participant is 6 months, with evaluations at baseline, 3 months, and 6 months.

Optimal Pacing Rate for Cardiac Resynchronization Therapy