Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure

M. T. Huttelmaier1, S. Münsterer2, C. Morbach3, F. Sahiti2, N. Scholz2, J. Albert2, C. E. Angermann4, G. Ertl4, S. Frantz4, S. Störk2, T. H. Fischer1

1Med. Klinik und Poliklinik I, Klinische Elektrophysiologie, Universitätsklinikum Würzburg, Würzburg; 2Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg; 3Medizinische Klinik I, Kardiologie, Universitätsklinikum Würzburg, Würzburg; 4Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg;

Introduction: In patients with heart failure (HF), chronotropic incompetence is a major factor limiting cardiac output. In patients carrying cardiac implantable electronic devices (CIED), accelerometer-based rate adaption (R-mode) counterbalances chronotropic incompetence during physical activity, but fails to modulate heart rate in situations of high metabolic demand. We hypothesized that an activated R-mode, a reasonable surrogate of chronotropic incompetence, indicates worse prognosis during episodes of acutely decompensated HF (AHF). Methods and Results: The current report is based on 632 patients enrolled in the AHF registry that phenotypes patients admitted for AHF. We compared CIED carriers with activated R-mode stimulation (CIED-R; n=37, 16.2% women) with CIED carriers not in R-mode (CIED-0; n=64, 23.4% women) and patients without CIEDs (no-CIED; n=511, 43.2% women). Mean heart rate at admission was lower in CIED-R vs CIED-0 or no-CIED: 70 bpm vs 80 bpm or 82 bpm; both p<0.001. In-hospital mortality was similar across groups, but 12-month mortality risk was differentially affected by R-mode activation when adjusting for age and sex: CIED-R vs CIED-0, hazard ratio (HR) 2.44, 95%CI 1.25–4.74; CIED-R vs no-CIED, HR 2.61, 95%CI 1.59–4.29. Within CIED-R, mortality risk was similar in patients with pacemakers vs ICDs (HR 1.20, 95%CI 0.49–2.95) and in subgroups with LVEF ≥50% vs <50% (HR 1.10, 95% CI 0.79–1.53). Conclusion: In patients admitted for decompensated heart failure, R-mode stimulation was associated with a markedly higher 12-month mortality risk. Since an activated R-mode is a plausible indicator of chronotropic incompetence, our findings suggest that chronotropic incompetence per se mediates an adverse outcome and may not be adequately treated through accelerometer-based R-mode stimulation in situations of increased metabolic demand.

https://dgk.org/kongress_programme/jt2022/aP847.html