Impact of Optimized Pacing Strategies on Clinical and Hemodynamic Outcomes in Heart Failure Patients With Pacemaker

Inclusion criteria

• Patients with symptomatic bradycardia who meet the indication for permanent pacemaker implantation and fulfill one of the following conditions:
• Sick sinus syndrome with or without impaired atrioventricular conduction
• Persistent or permanent atrial fibrillation with slow ventricular response
• Chronotropic incompetence
• Patients diagnosed with heart failure with left ventricular ejection fraction ≥ 50% on transthoracic echocardiography with at least one of the following:
• H2FPEF score ≥ 6 or HFA-PEFF score ≥ 5
• N-terminal pro-B-type natriuretic peptide ≥ 300 pg/mL (sinus rhythm) or ≥ 600 pg/mL (atrial fibrillation)
• Prior hospitalization for heart failure or documented use of loop diuretics for heart failure symptoms

Exclusion criteria

• Patients expected to have a ventricular pacing burden ≥ 20% without sufficient capture of cardiac physiologic pacing, which includes biventricular pacing, His bundle pacing, and left bundle branch area pacing.
• Sufficient cardiac physiologic pacing is defined as a paced QRS duration ≤ 140 ms.)
• Patients not expected to achieve sufficient pacing dependency, defined as:
• In sinus rhythm: baseline atrial rate \> 60 bpm on Holter monitoring or inpatient ECG monitoring
• In atrial fibrillation/flutter: baseline ventricular rate \> 60 bpm on Holter monitoring or inpatient ECG monitoring
• Patients with contraindications to permanent pacemaker implantation
• Patients with moderate or greater valvular stenosis or regurgitation.
• Patients with dyspnea not attributable to heart failure, due to uncontrolled comorbid conditions
• Pregnant or breastfeeding women.
• Patients who have refused active treatment.