Heart Rate Clinical Trial
Official title:
Work Intolerance in Left Ventricular Assist Device Recipients: Impact of Pacing
Implantation with left ventricular assist device (LVAD) in patients with end-stage heart
failure (HF) leads to improvements in survival and quality of life, however, work capacity
remains disappointingly low, at half of the expected value. Complex central and peripheral
hallmarks of heart failure attribute to the continued work intolerance, to which heart rate
may be a contributing factor.
The purpose of this study is to clarify the impact of heart rate (by means of pacing) on work
capacity (measured as peak oxygen uptake) in LVAD recipients.
While implantation with left ventricular assist devices (LVADs) in patients with end-stage
heart failure (HF) improve survival and quality of life, work capacity remains at a
disappointing 50% of the expected value.
Due to the worldwide (increasing) shortage of donor hearts, LVADs are increasingly used as
destination therapy which makes it crucial for physicians to persistently identify
opportunities to improve management, lower the adverse events and maximize the benefits of
this treatment option.
In recent years it was found that upregulation of device pump speed improves the maximal work
capacity of LVAD recipients with no side effects. More recently it was found that the
patients' heart rate reserve also was of importance in this regard, however, the latter was
shown in a retrospective study and needs to be confirmed in a prospective randomized
double-blinded intervention study. As a large portion of LVAD recipients are already
implanted with a pacing device (and suffer from chronotropic incompetence) such a study is
possible to conduct by controlling their heart rate during exercise by pacing (ie randomized
crossover design).
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