JAMA Cardiology Author Interviews Clinical Outcomes With Personalized Accelerated Physiologic Pacing in HFpEF
Aug 27, 2025
In this engaging discussion, Margaret Infeld, an electrophysiologist at Tufts Medical Center, delves into her groundbreaking MyPACE study on heart failure with preserved ejection fraction. She reveals how personalized accelerated physiologic pacing can significantly improve patient quality of life. Infeld highlights the benefits of higher heart rates in reducing filling pressures and discusses captivating findings on long-term events, medications, and potential future trials integrating AI for better patient selection.
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Higher Resting Rate Improved Symptoms
- Moderately increasing resting heart rate improved quality of life in HFpEF patients with physiologic pacemakers.
- The myPACE group averaged 75 bpm versus 65 bpm in controls and showed better symptoms and activity.
Pacing Lowers Filling Pressures
- Acute invasive studies show atrial pacing lowers LV diastolic and left atrial pressures up to a sweet‑spot rate.
- Infeld links chronic modest rate increase to sustained lower filling pressures and reduced NT‑proBNP.
Remodeling And Curve Dynamics Explain Benefit
- Modest faster pacing may move HFpEF patients down the steep part of the end‑diastolic pressure–volume curve, lowering pressures disproportionately.
- Animal and echo analyses suggested decreased LV mass-to-volume ratio and wall thickness with long‑term pacing.