Effective use of a novel rate-smoothing algorithm in atrial fibrillation by ventricular pacing

Abstract

This initial study of the novel rate-smoothing algorithm shows that pacing intervention is a relatively safe, rapid and reliable alternative therapy for controlling irregular ventricular rhythms due to atrial fibrillation. Incorporation of the algorithm in implantable pacemakers appears justified, but demands further prospective studies in patients to evaluate relief of symptoms and reduction of tachycardiomyopathy due to atrial fibrillation.

Ventricular rate smoothing for atrial fibrillation: a quantitative comparison study

“…As expected, all VP protocols ( Figure 2B-H) effectively regularize the ventricular rate through ventricular pacing that eliminates long RR intervals. In agreement with previous studies, [5][6][7][8][9][10][11][12][13][14]22 the incidence of rapid intrinsic beats (e.g. with RR , 500 ms) is also reduced.…”

“…[2][3][4] Previous studies have demonstrated that some specially designed ventricular pacing (VP) protocols could reduce the ventricular irregularity in AF. [5][6][7][8][9][10][11][12][13][14] The ventricular ratesmoothing (VRS) algorithms were perceived advantageous than the fixed-rate VP scheme because the former could automatically vary the pacing cycle length (PCL) based on measured ventricular rate and/or its regularity. 6,[8][9][10][11][12][13][14] On the other hand, some of these VRS algorithms can result in aggressive VP and unconditional suppression of intrinsic ventricular depolarization, which may offset the benefit offered by the rate regularization.…”

Role of Rate Control and Regularization Through Pacing in Patients With Chronic Atrial Fibrillation and Preserved Ventricular Function: The VRR Study

“…Most of them increase the pacing rate slightly in response to sensed events and reduce it following consecutive paced events. 14,15 The effect is to suppress long RR intervals and reduce short RR intervals through the effect of retrogradely conducted impulses from the pacing site. 16 Even though the beneficial hemodynamic effects of these pacing methods have been tested in acute settings, [17][18][19] to our knowledge, no clinical study has yet demonstrated significant improvements over time to support the daily activity of AF patients implanted with PM.…”

“…Recently, specific ventricular pacing algorithms have been designed and built into permanent pacemakers (PM) so to achieve dynamic rate regularization. Most of them increase the pacing rate slightly in response to sensed events and reduce it following consecutive paced events 14,15 . The effect is to suppress long RR intervals and reduce short RR intervals through the effect of retrogradely conducted impulses from the pacing site 16 .…”

Intermittent inhibition of biventricular pacing in a cardiac resynchronization therapy defibrillator

“…Rate smoothing algorithms are used to regularize the ventricular response in patients with irregular heart rhythms such as atrial fibrillation, 2 2:1 AV block or Wenckebach-type heart block, 3 and frequent ventricular ectopy. Rate smoothing has also been reported to prevent torsades de pointes in patients with long QT syndrome.…”