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.

中文翻译：

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加速心房起搏降低左心充盈压：一项临床计算联合研究


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 （HFpEF） 和心房颤动 （AF） 的心力衰竭患者提供了潜在益处。该研究调查了心房起搏率与左心充盈压之间的关系。方法 连续 75 例接受导管消融术治疗 AF 的患者接受了平均左心房压 （mLAP） 和房室 （AV） 传导延迟 （PR 间期） 窦性心律和加速心房起搏的评估，增量为 10 次/分，直至 Wenckebach 阻滞。虚拟 HFpEF 队列的计算机模拟 （CircAdapt） 补充了临床观察，并假设了 AV 耦合和心房（dys）功能的调节作用。结果 在研究队列中，49 例 （65%） 患者具有高 HFpEF 可能性 （H2FPEF ≥ 5.0），28 例 （37%） 患者在窦性心律时 mLAP 升高≥ 15 mmHg。最佳起搏率为 100 [70–110] bpm（中位数 [IQR]），mLAP 从窦性心律的 12.8 [10.0–17.4] mmHg （55 [52–61] bpm） 显著降低至 10.4 [7.8–14.8] mmHg （P < .001）。相反，较高的起搏率 （130 [110–140] bpm） 显着增加 mLAP 至 14.7 [11.0–17.8] mmHg （P < .05）。PR 间期，因此，房室传导延迟随着起搏率的增加而逐渐延长。模拟证实了这些临床发现，显示 mLAP 以适度增加的起搏率降低，随后以更高的速率增加。此外，模拟表明，当 AV 传导延迟随着速率的增加而缩短时，mLAP 降低得到优化。 结论 加速起搏可显著降低接受 AF 导管消融术和具有 HFpEF 特征的计算机模拟患者的左心充盈压，表明它是缓解充血症状的潜在治疗策略。虚拟 HFpEF 患者队列假设 AV 序贯起搏可能会进一步优化这种疗法的有益效果。