Cardiac Device for Symptomatic Bradycardia Co-Existing with Heart Failure with Preserved Ejection (HFpEF): A Prospective Study in South-South Nigeria

Abstract

Background: The choice of cardiac device for a patient with HFpEF and symptomatic bradycardia may be difficult to select. The reason is that there is not much data on this at the moment. Objective: The study objective was to investigate HFpEF and symptomatic bradycardia on the need for an appropriate cardiac device. Methods: This was a prospective study involving patients with HFpEF coexisting with complete heart block (CHB). It is a prospective observational study carried out at the University of Port Harcourt teaching hospital (UPTH) and the Bayelsa specialist hospital for a period of 2 years. There were 19 patients with an indication for HFpEF and CHB. Nine patients received DDD pacemaker, 9 received a CRTP, and 1 had an LBBAP. They were followed up for 1 year and the outcome of the upgrade was documented if a patient had it. Results: The average age was 71.26 ± 9.65 years. The average ejection fraction is 61.26 ± 5.55%. The common symptoms presented were leg swelling, orthopnea, cough, shortness of breath and PND. Among patients initially implanted with DDD, 66.7% required device upgrade compared to 0% among those with other devices (χ² = 9.744, p = 0.003). Patients with DDD were 3 times more likely to require an upgrade compared to those with other devices (OR = 3.0, 95% CI: 1.2–7.6).  Conclusion: Heart Failure with Preserved Ejection Fraction (HFpEF) and Complete Heart Block (CHB) are two distinct, yet potentially interrelated, cardiovascular conditions that, when coexisting, create a high-risk scenario due to the combined impact on ventricular filling and heart rate. To avoid creating left bundle branch block from pacing, CRTP is and LBBAP are suggested in patient who has the two existing medical conditions.