Highlight
• In patients with heart failure with preserved ejection fraction (HFpEF) and physiologic pacemakers, personalized accelerated pacing above the conventional 60 bpm standard demonstrated slower adverse event accrual in per-protocol analysis.
• The myPACE trial observational follow-up over 4 years showed that patients adhering to personalized pacing had fewer heart failure–related hospitalizations and improved event-free survival.
• Intention-to-treat analysis trended towards benefit but did not reach statistical significance, highlighting the need for further validation in larger trials.
