Eraldo Occhetta1, Gianfranco Mazzocca2, Carla Svetlich3, Pietro Scipione4, Alessandro Fabiani5, Massimo Giammaria6, Serafino Orazi7, Giorgio Corbucci8. 1. Cardiology Department, AOU Maggiore della Carità, Novara, Italy. 2. Cardiology Department, Ospedale di Cecina, Azienda USL 6, Livorno, Italy. 3. Cardiology Department, Ospedale Versilia di Camaiore, Lido di Camaiore, Italy. 4. Cardiology Department, Ospedali Riuniti Umberto I - GM Lancisi - G Salesi, Ancona, Italy. 5. Cardiology Department, Ospedale Area Aretina Nord, Arezzo, Italy. 6. Cardiology Department, Ospedale Maria Vittoria, Torino, Italy. 7. Cardiology Department, Azienda Sanitaria Locale, Rieti; Italy. 8. Formely, Medtronic BRC, Maastricht, The Netherlands.
Abstract
Background: In patients with permanent atrial fibrillation (AF) rate irregularity can cause symptoms and impair the pumping function of the heart. Ventricular pacing at a rate close to the mean spontaneous ventricular rate can result in a more stable ventricular rate. Specific algorithms for automatic Ventricular Rate Stabilization (VRS) were designed and implemented in commercially available pacemakers. To assess this dynamic rate control we designed the RARE-PEARL study: prospective, randomized, cross-over, double-blinded. Methods:Patients with permanent AF, symptomatic episodes of brady-tachycardia, left ventricular ejection fraction (LVEF) >40%, NYHA class I/II/III, were eligible for enrolment. Each patient (n = 67) was implanted with a single-chamber VVIR pacemaker (models C20 or T20, Vitatron BV, The Netherlands) equipped with the VRS algorithm. At the end of a four week stabilization period, patients were randomized to VRS algorithm ON or OFF (2 months) and then crossed-over for the second phase (2 months). Primary endpoint was patient's preference. Results:Sixty six patients ended the study: 19 (29%) had no preference; 15 (23%) preferred algorithm OFF, 32 (48%) algorithm ON (p<0.0001, algorithm ON vs OFF). In 58% of patients the algorithm ON caused an increase of ventricular pacing percentage > 10%. The ventricular pacing percentage was 82±10% with algorithm ON vs 59±26% with algorithm OFF (p<0.0001). Symptoms did not differ significantly. Conclusions: The VRS algorithm significantly increases the ventricular pacing percentage in patients with permanent AF. This pacing function is preferred by the majority of patients implanted with a single-chamber VVIR pacemaker.
RCT Entities:
Background: In patients with permanent atrial fibrillation (AF) rate irregularity can cause symptoms and impair the pumping function of the heart. Ventricular pacing at a rate close to the mean spontaneous ventricular rate can result in a more stable ventricular rate. Specific algorithms for automatic Ventricular Rate Stabilization (VRS) were designed and implemented in commercially available pacemakers. To assess this dynamic rate control we designed the RARE-PEARL study: prospective, randomized, cross-over, double-blinded. Methods:Patients with permanent AF, symptomatic episodes of brady-tachycardia, left ventricular ejection fraction (LVEF) >40%, NYHA class I/II/III, were eligible for enrolment. Each patient (n = 67) was implanted with a single-chamber VVIR pacemaker (models C20 or T20, Vitatron BV, The Netherlands) equipped with the VRS algorithm. At the end of a four week stabilization period, patients were randomized to VRS algorithm ON or OFF (2 months) and then crossed-over for the second phase (2 months). Primary endpoint was patient's preference. Results: Sixty six patients ended the study: 19 (29%) had no preference; 15 (23%) preferred algorithm OFF, 32 (48%) algorithm ON (p<0.0001, algorithm ON vs OFF). In 58% of patients the algorithm ON caused an increase of ventricular pacing percentage > 10%. The ventricular pacing percentage was 82±10% with algorithm ON vs 59±26% with algorithm OFF (p<0.0001). Symptoms did not differ significantly. Conclusions: The VRS algorithm significantly increases the ventricular pacing percentage in patients with permanent AF. This pacing function is preferred by the majority of patients implanted with a single-chamber VVIR pacemaker.
Entities:
Keywords:
Biventricular Pacing; Catheter Ablation of the Atrioventricular Node; Right Ventricular Pacing; Ventricular Tachycardia
Authors: Gianfranco Ciaramitaro; Giuseppe Sgarito; Francesco Solimene; Gianpiero Maglia; Alfredo Vicentini; Giovanni DI Donato; Giovanni Raciti; Giovanni Parrinello; Giovanni Battista Del Giudice Journal: Pacing Clin Electrophysiol Date: 2006-08 Impact factor: 1.976
Authors: E G Daoud; R Weiss; M Bahu; B P Knight; F Bogun; R Goyal; M Harvey; S A Strickberger; K C Man; F Morady Journal: Am J Cardiol Date: 1996-12-15 Impact factor: 2.778
Authors: M Brignole; L Gianfranchi; C Menozzi; P Alboni; G Musso; M G Bongiorni; M Gasparini; A Raviele; G Lolli; N Paparella; S Acquarone Journal: Circulation Date: 1997-10-21 Impact factor: 29.690
Authors: G E Kochiadakis; E I Skalidis; M D Kalebubas; N E Igoumenidis; S I Chrysostomakis; E M Kanoupakis; E N Simantirakis; P E Vardas Journal: Eur Heart J Date: 2002-05 Impact factor: 29.983