Effectiveness of rate-adaptive pacing on patients with chronotropic incompetence: Systematic review and meta-analysis of randomized controlled trials

The HFA-PEFF score and outcomes in patients with sick sinus syndrome and preserved ejection fraction after pacemaker implantation

Background

Sick sinus syndrome (SSS) is associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). However, diagnosing HFpEF in patients with SSS and determining its prognosis are challenging. The European Society of Cardiology has recommended the HFA-PEFF score for HFpEF diagnosis. In this study, we utilized the HFA-PEFF score to diagnose HFpEF in patients with SSS and preserved ejection fraction, comparing the prognosis and AF burden between those diagnosed with HFpEF and those without.

Methods

We identified 131 patients with symptomatic SSS and preserved ejection fraction who underwent pacemaker implantation between January 2019 and December 2021. Of these, 52 (39.7%) had an HFA-PEFF score ≥5 and met the diagnostic criteria for HFpEF.

Results

Patients with HFpEF experienced more cardiovascular events (28.8% vs. 11.4%; p = .009) within 3 years than those without HFpEF. The median duration of AF per day during the first year was significantly longer in the HFpEF group (10 vs. 30 min/day, p < .001). Additionally, these patients had a higher incidence of AF lasting for ≥7 days (32.9% vs. 16.9%; p = .038) within 3 years. A simplified HFA-PEFF score incorporating E/e', tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide predicted cardiovascular events and AF burden.

Conclusions

Patients diagnosed with HFpEF using the HFA-PEFF score have a higher incidence of cardiovascular events and a greater AF burden within 3 years after pacemaker implantation for SSS. The HFA-PEFF score may be useful for risk stratification in these patients.