Dynamic ventricular overdrive stimulation in atrial fibrillation: effects on ventricular rate irregularity, ventricular pacing, and fusion beats
| Autor: | Guido Ritscher, Peter Boileau, Harald Marschang, Johannes Brachmann, Michael Benser, Klaus-Jürgen Gutleben, Georg Nölker, Benoit Hallier, Stefan Asbach, Anil M. Sinha, Alexander Hümmer |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Ventricular rate Pacemaker Artificial Beats per minute Heart Ventricles Stimulation Cardiac Resynchronization Therapy Electrocardiography Heart Conduction System Heart Rate Physiology (medical) Heart rate Atrial Fibrillation medicine Supine Position Humans cardiovascular diseases Lead (electronics) Aged business.industry Atrial fibrillation Mean age Ventricular pacing Middle Aged medicine.disease Anesthesia cardiovascular system Atrioventricular Node Female Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 13(12) |
| ISSN: | 1532-2092 |
| Popis: | Aims In pacemaker patients with preserved atrio-ventricular (AV) conduction, atrial fibrillation (AF) can lead to symptomatic ventricular rate irregularity and loss of ventricular stimulation. We tested if dynamic ventricular overdrive (DVO) as a potentially pacemaker-integrated algorithm could improve both aspects. Methods and results Different settings of DVO and ventricular–ventricular-inhibited-pacing (VVI) with different base rates were tested in two consecutive phases during electrophysiological studies for standard indications. Mean heart rate (HR), HR irregularity and percentage of ventricular pacing were evaluated. A fusion index (FI) indicative of the proportion of fusion beats was calculated for each stimulation protocol. Dynamic ventricular overdrive from the right ventricular apex was acutely applied in 38 patients (11 females, mean age 62.1 ± 11.5 years) with sustained AF and preserved AV conduction. Dynamic ventricular overdrive at LOW/MEDIUM setting increased the amount of ventricular pacing compared with VVI pacing at 60, 70, and 80 beats per minute (bpm; to 81/85% from 11, 25, and 47%, respectively; P < 0.05). It also resulted in a maximum decrease in interval differences (to 48 ± 18 ms from 149 ± 28, 117 ± 38, and 95 ± 46 ms, respectively; P < 0.05) and fusion (to 0.13 from 0.41, 0.42, and 0.36, respectively; P < 0.05) compared with VVI pacing at 60, 70, and 80 bpm. However, the application of DVO resulted in a significant increase in HR compared with intrinsic rhythm and VVI pacing at 80 bpm (to 97 bpm from 89 and 94 bpm, respectively; P < 0.05). Conclusion Dynamic ventricular overdrive decreases HR irregularity and increases ventricular pacing rate compared with VVI pacing at fixed elevated base rates and spontaneous rhythm. Fusion index might help to refine information on pacing percentages provided by device counters. |
| Databáze: | OpenAIRE |
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