Cs. Simpson et al., Safety and feasibility of a novel rate-smoothed ventricular pacing algorithm for atrial fibrillation, AM HEART J, 142(2), 2001, pp. 294-300
Citations number
25
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives This study was conducted to establish the safety and performance
of a new rate-smoothing pacing algorithm for patients with atrial fibrilla
tion (AF).
Background Irregularity of the ventricular response is a hallmark of AF. Th
is irregularity may contribute to symptoms and hemodynamic compromise in pa
tients with AF. Interventions designed to reduce irregularity have not prev
iously been evaluated in a long-term, clinical setting.
Methods We designed a prospective, double-blind study with randomized cross
over. Patients with either paroxysmal or chronic AF whose conditions were m
edically refractory and who were referred for an atrioventricular node abla
tion procedure all underwent pacemaker implantation. Subjects were then ran
domly assigned to either DDD mode with the rate-smoothing algorithm (RSA) o
n, or to OOO mode. After 2 months they were crossed over to the other arm.
Results Fourteen patients (9 with paroxysmal AF and 5 with chronic AF) were
enrolled. There were no significant differences between the group randomly
assigned to RSA first versus the group assigned to OOO first. The mean lef
t ventricular ejection fraction with the RSA was not significantly differen
t than it was in OOO mode (45.1 +/- 18.6 vs 51.9 +/- 12.3; P = .11), althou
gh some individuals with uncontrolled ventricular rates did have a large de
crease in ejection fraction with rate smoothing. One developed overt heart
failure. One quality-of-life instrument detected a significant improvement
in the "physical limitations" domain with the rate-smoothing mode. Eleven o
f 14 patients preferred the RSA ON arm, and 6 of those 11 elected to defer
the ablation procedure.
Conclusions Long-term rate-smoothed pacing is feasible. Because of concerns
about pacing-induced heart failure in some patients with rapid ventricular
rates, rate-smoothed pacing should be reserved for those who remain sympto
matic despite adequate control of the ventricular rate. The RSA may help to
reduce symptoms in patients with medically refractory AF; more study is re
quired to define its efficacy in reducing symptoms and morbidity in this po
pulation.