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

Abstract

VRR effectively stabilizes rate, without increasing pacing rate above spontaneous rhythm and helps achieve a more favorable autonomic balance, improving rate recovery after exercise.

Impact of Right Ventricular Pacing Sites on Exercise Capacity during Ventricular Rate Regularization in Patients with Permanent Atrial Fibrillation

“…1). 7 The patients were randomized using a randomization table at the time of implantation to receive a ventricular lead at either the RVA (passive‐fixation lead, Fig. 2A) or the RVS (active‐fixation lead, Fig.…”

“…Previous clinical studies demonstrated that ventricular overdrive pacing can regularize ventricular rate (VR) during atrial fibrillation (AF) to improve cardiac hemodynamic status 1–4 . However, the use of different ventricular overdrive pacing algorithms in patients with AF only demonstrated limited benefit on exercise capacity 5–7 . The potential benefit of VR regularization (VRR) may be offset by the adverse hemodynamic effects of right ventricular apical (RVA) 8,9 .…”

“…The potential benefit of VR regularization (VRR) may be offset by the adverse hemodynamic effects of right ventricular apical (RVA) 8,9 . Therefore, the use of RVA pacing in prior studies related to the use of VRR pacing algorithm may contribute to the lack of benefit observed 5–7 . However, it is unknown that whether the use of right ventricular septal (RVS) to avoid the potential harmful effects of RVA pacing can provide incremental benefit with VRR pacing during AF.…”

Cardiac resynchronization therapy in heart failure patients with atrial fibrillation

“…14,15 The benefits of rate control achieved by activating VRR function is well established in patients with chronic AF and no or only mild HF treated with a single chamber right ventricular (RV) pacing. In these patients, VRR has been demonstrated to confer acute haemodynamic benefits, 16 to restore autonomic balance, 17 and to provide a more regular rhythm during exercise, 14 thus potentially improving functional status.…”

“…Another useful feature is ‘ventricular sense response’ (also called ‘trigger’ function) which triggers LV pacing after a premature RV sense event is detected: 17 this option may be activated in all CRT devices of the latest generation.…”