Adaptive Heart Rate Control in Atrial Fibrillation and Heart Failure: Insights from a Multimodal Monitoring and Intervention Trial
Full Text:
Abstract
Atrial fibrillation (AF) in chronic heart failure (CHF) presents unique challenges for heart rate management, with current evidence suggesting that traditional heart rate control strategies may not improve survival outcomes in this cohort as they do in patients with sinus rhythm (SR). This study aims to advance understanding by investigating personalized and adaptive heart rate management strategies tailored to CHF patients with AF. We propose a randomized controlled trial to compare individualized heart rate control—guided by patient-specific biomarkers, autonomic nervous system assessment, and heart rate variability (HRV) monitoring—with conventional heart rate management. Additionally, this study will examine the impact of real-time, multimodal monitoring via wearable devices, allowing dynamic adjustments to heart rate control based on patient response. A cohort of CHF patients with AF will undergo continuous HRV and rhythm monitoring, coupled with regular biomarker evaluations, to assess correlations between heart rate dynamics and survival. Advanced pharmacological (e.g., ivabradine) and device-based therapies (e.g., implantable cardioverter-defibrillators) will be integrated to evaluate their roles in enhancing heart rate management outcomes. We hypothesize that this personalized, real-time approach will reduce mortality, improve quality of life, and provide insights into the pathophysiological differences that underlie heart rate impacts in AF versus SR in CHF. This study could shift current paradigms in CHF management, promoting a precision-medicine approach to heart rate control for AF patients with heart failure.JRCD 2022; 4(6): 133–137
Keywords
cardiopulmonary function, muscle strength, quality of life, left ventricular ejection fraction, NT-proBNP, genomic analysis, proteomic analysis
References
Rienstra M, Van Gelder IC, Van den Berg MP, Boomsma F, Hillege HL, Van Veldhuisen DJ. A comparison of low versus high heart rate in patients with atrial fibrillation and advanced chronic heart failure: effects on clinical profile, neurohormonaes and survival. Int J Cardiol 2006;109:95–100.
Thomas G, Kim J, Lerman BB. Improving cardiac resynchronisation therapy. Arrhythmia & Electrophysiology Review. 2019 Jul;8(3):220.
Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017 Nov 7;136(19):1840-50.
Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CS, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. Journal of the American College of Cardiology. 2014 Apr 1;63(12):1123-33.
Di Cesare, E., Carerj, S., Palmisano, A., Carerj, M.L., Catapano, F., Vignale, D., Di Cesare, A., Milanese, G., Sverzellati, N., Francone, M. and Esposito, A., 2021. Multimodality imaging in chronic heart failure. La radiologia medica, 126, pp.231-242.
Kirchhof P, Bax J, Blomstrom-Lundquist C, Calkins H, Camm AJ, Cappato R, Cosio F, Crijns H, Diener HC, Goette A, Israel CW. Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference ‘research perspectives in AF’. European heart journal. 2009 Dec 1;30(24):2969-80.
Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. Journal of the American College of Cardiology. 2002 Jul 3;40(1):111-8.
Vervoort D, Tam DY, Wijeysundera HC. Health technology assessment for cardiovascular digital health technologies and artificial intelligence: why is it different?. Canadian Journal of Cardiology. 2022 Feb 1;38(2):259-66.
Casaclang-Verzosa G, Gersh BJ, Tsang TS. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. Journal of the American College of Cardiology. 2008 Jan 1;51(1):1-1.
Mullens W, Grimm RA, Verga T, Dresing T, Starling RC, Wilkoff BL, Tang WW. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. Journal of the American College of Cardiology. 2009 Mar 3;53(9):765-73.
Smiseth OA, Baron T, Marino PN, Marwick TH, Flachskampf FA. Imaging of the left atrium: pathophysiology insights and clinical utility. European Heart Journal-Cardiovascular Imaging. 2022 Jan 1;23(1):2-13.
Gautam N, Ghanta SN, Mueller J, Mansour M, Chen Z, Puente C, Ha YM, Tarun T, Dhar G, Sivakumar K, Zhang Y. Artificial Intelligence, Wearables and Remote Monitoring for Heart failure: current and future applications. Diagnostics. 2022 Nov 26;12(12):2964.
McAlister FA, Wiebe N, Ezekowitz JA, Leung AA, Armstrong PW. Meta-analysis: β-blocker dose, heart rate reduction, and death in patients with heart failure. Annals of Internal Medicine. 2009 Jun 2;150(11):784-94.
Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, Tu JV, Levy D. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute. Circulation. 2009 Jun 23;119(24):3070-7.
Diller GP, Arvanitaki A, Opotowsky AR, et al. Lifespan perspective on congenital heart disease research: JACC state-of-the-art review. Journal of the American College of Cardiology. 2021 May 4;77(17):2219-35.
Refbacks
- There are currently no refbacks.
