Kuroda Shunsuke, Kawamura Iwanari, Sahashi Yuki, Tonegawa-Kuji Reina, Kuno Toshiki
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiology, Institute of Science Tokyo, Tokyo, Japan.
Int J Cardiol. 2025 Mar 15;423:133022. doi: 10.1016/j.ijcard.2025.133022. Epub 2025 Jan 30.
Rate-adaptive pacing (RAP) complements heart rate (HR) responses in patients with cardiac pacing devices and chronotropic incompetence, although improvements in exercise capacity have varied across reported studies. The purpose of this study was to evaluate the effectiveness of the RAP mode across different clinical settings.
A systematic review and meta-analysis were conducted according to PRISMA guidelines. MEDLINE and EMBASE databases were searched through May 2024. Randomized controlled trials comparing RAP-on with RAP-off modes in patients with chronotropic incompetence were included. Outcomes related to exercise capacity, such as peak oxygen uptake (VO2), exercise duration, and patient-reported outcomes (PROs), were analyzed.
Twelve trials with a total of 1199 patients were included. The meta-analysis showed that RAP-on significantly improved peak VO2 (mean difference [MD]: 1.35 ml/kg/min, 95 % confidence interval [CI]: 0.47 to 2.23) and exercise duration (MD:0.74 min, 95 % CI: 0.14 to 1.33) with augmenting peak HR (MD: 19 bpm, 95 % CI: 13 to 26) during cardiopulmonary exercise tests. The effectiveness of RAP on exercise capacity blunted particularly in patients with heart failure (HF) (MD: 0.36 ml/kg/min, 95 % CI: -0.88 to 1.60) compared with those without HF (MD: 1.95 ml/kg/min, 95 % CI: 0.66 to 3.23). PROs showed no significant improvement with RAP-on except for one study including non-HF.
RAP-on mode significantly enhances exercise capacity in patients with chronotropic incompetence, however, the benefits are less pronounced in patients with concomitant HF. In patient with HF, careful assessment is crucial to identify potential need for advanced therapeutic approach following the RAP-on pacing.
频率适应性起搏（RAP）可辅助心脏起搏装置和变时性功能不全患者的心率（HR）反应，尽管不同研究报道的运动能力改善情况有所不同。本研究的目的是评估RAP模式在不同临床环境中的有效性。
根据PRISMA指南进行系统评价和荟萃分析。检索MEDLINE和EMBASE数据库至2024年5月。纳入比较变时性功能不全患者RAP开启与关闭模式的随机对照试验。分析与运动能力相关的结果，如峰值摄氧量（VO2）、运动持续时间和患者报告的结果（PROs）。
纳入12项试验，共1199例患者。荟萃分析表明，在心肺运动试验期间，开启RAP可显著提高峰值VO2（平均差值[MD]：1.35 ml/kg/min，95%置信区间[CI]：0.47至2.23）和运动持续时间（MD：0.74分钟，95%CI：0.14至1.33），同时增加峰值心率（MD：19次/分钟，95%CI：13至26）。与无心力衰竭（HF）的患者相比，RAP对运动能力的有效性在HF患者中尤其减弱（MD：0.36 ml/kg/min，95%CI：-0.88至1.60）（MD：1.95 ml/kg/min，95%CI：0.66至3.23）。除一项纳入非HF患者的研究外，PROs在开启RAP时未显示出显著改善。
开启RAP模式可显著提高变时性功能不全患者的运动能力，然而，在合并HF的患者中益处不那么明显。对于HF患者，仔细评估对于确定开启RAP起搏后对高级治疗方法的潜在需求至关重要。
