title: Ventricular rate smoothing for atrial fibrillation: a quantitative comparison study.
abstract: OBJECTIVE
  To quantitatively compare the ventricular rate-smoothing (VRS) effects of different ventricular pacing (VP) protocols for atrial fibrillation (AF).
  
  
  RESULTS
  Using a recently developed open-source model that can simulate the ventricular response in AF and VP, the performance of fixed-rate pacing and four previously published VRS algorithms were assessed by the mean RR (mRR), the root mean square of successive RR differences (RMSSD), the percentage of ventricular senses (VS%), and the percentage of short RR intervals (sRR%). All pacing protocols cause rate-dependent reduction of RMSSD, VS%, and sRR% with or without shortening of mRR compared to spontaneous AF. Fixed-rate pacing was more sensitive to the intrinsic rate than the VRS algorithms. The performance was generally comparable between different VRS algorithms, although higher mRR and VS% can be achieved at the expense of larger RMSSD and sRR%.
  
  
  CONCLUSIONS
  The effect of VP on ventricular rhythm in AF depends on both intrinsic rate and the aggressiveness of the pacing protocol. Adequate rate control is necessary for effective operation of the VRS algorithm. Choosing VRS algorithm should balance between the beneficial effects of rate regularization and the negative effects of increasing heart rate and percentage of VP.
authors.affiliation: Applied Clinical Research Department, Micro Systems Engineering, Inc., 6024 SW Jean Road, Lake Oswego, OR 97035, USA. jie.lian@biotronik.com
authors.forename: Jie
authors.initials: J
authors.lastname: Lian
authors.forename: Dirk
authors.initials: D
authors.lastname: Müssig
authors.forename: Volker
authors.initials: V
authors.lastname: Lang
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003198:Computer Simulation; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology* / Q000628:therapy*