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. 1994 Jun;71(6):536–540. doi: 10.1136/hrt.71.6.536

Short-term effects of right atrial, right ventricular apical, and atrioventricular sequential pacing on myocardial oxygen consumption and cardiac efficiency in patients with coronary artery disease.

Z S Kyriakides 1, A Antoniadis 1, E Iliodromitis 1, N Michelakakis 1, D T Kremastinos 1
PMCID: PMC1025448  PMID: 8043333

Abstract

OBJECTIVE--To investigate the short-term effects of atrial, atrioventricular, and ventricular pacing on myocardial oxygen consumption, myocardial blood flow, and cardiac efficiency in patients with coronary artery disease. DESIGN--Prospective study that started at the end of diagnostic coronary angiography in 13 patients and was performed during atrial, atrioventricular, and ventricular pacing for 5 min, in random order, at 20 beats/min more than the heart rate of the patient's positive exercise test. A Baim thermodilution catheter in the coronary sinus was used to measure myocardial blood flow and oxygen consumption and a pacing electrode at the right ventricular apex and a catheter in the pulmonary artery were used to estimate cardiac output. SETTING--Referral cardiology centre. PATIENTS--13 patients with coronary artery disease (mean (SD) age 53(5) years). All the patients had a positive exercise test and most of them (77%) had left anterior descending coronary artery disease. RESULTS--Mean (SD) cardiac output increased by 0.5(1.6) l/min during atrial pacing, increased by 0.1(1) l/min during atrioventricular pacing, and decreased by 0.8(1.2) l/min during ventricular pacing (P = 0.01 v atrial pacing, P = 0.03 v atrioventricular pacing). Diastolic pulmonary pressure increased by 6(4) mm Hg during atrial pacing, by 8.6(4) mm Hg during ventricular pacing (P = 0.02 v atrial pacing), and by 7.5(4.7) mm Hg during atrioventricular pacing. Changes in myocardial oxygen consumption and cardiac efficiency during the different pacing modes were similar. CONCLUSION--Atrial, atrioventricular, and ventricular pacing had similar short-term effects on myocardial oxygen consumption, myocardial blood flow, and cardiac efficiency in patients with coronary artery disease. Ventricular pacing, however, did not increase cardiac output.

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Selected References

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  1. Akhras F., Jackson G. Raised exercise diastolic blood pressure as indicator of ischaemic left ventricular dysfunction. Lancet. 1991 Apr 13;337(8746):899–900. doi: 10.1016/0140-6736(91)90216-c. [DOI] [PubMed] [Google Scholar]
  2. Badke F. R., Boinay P., Covell J. W. Effects of ventricular pacing on regional left ventricular performance in the dog. Am J Physiol. 1980 Jun;238(6):H858–H867. doi: 10.1152/ajpheart.1980.238.6.H858. [DOI] [PubMed] [Google Scholar]
  3. Baim D. S., Rothman M. T., Harrison D. C. Improved catheter for regional coronary sinus flow and metabolic studies. Am J Cardiol. 1980 Dec 1;46(6):997–1000. doi: 10.1016/0002-9149(80)90357-4. [DOI] [PubMed] [Google Scholar]
  4. Baller D., Wolpers H. G., Zipfel J., Bretschneider H. J., Hellige G. Comparison of the effects of right atrial, right ventricular apex and atrioventricular sequential pacing on myocardial oxygen consumption and cardiac efficiency: a laboratory investigation. Pacing Clin Electrophysiol. 1988 Apr;11(4):394–403. doi: 10.1111/j.1540-8159.1988.tb05998.x. [DOI] [PubMed] [Google Scholar]
  5. Boerth R. C., Covell J. W. Mechanical performance and efficiency of the left ventricle during ventricular stimulation. Am J Physiol. 1971 Dec;221(6):1686–1691. doi: 10.1152/ajplegacy.1971.221.6.1686. [DOI] [PubMed] [Google Scholar]
  6. Buckingham T. A., Janosik D. L., Pearson A. C. Pacemaker hemodynamics: clinical implications. Prog Cardiovasc Dis. 1992 Mar-Apr;34(5):347–366. doi: 10.1016/0033-0620(92)90039-3. [DOI] [PubMed] [Google Scholar]
  7. Kenny R. A., Ingram A., Mitsuoka T., Walsh K., Sutton R. Optimum pacing mode for patients with angina pectoris. Br Heart J. 1986 Nov;56(5):463–468. doi: 10.1136/hrt.56.5.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kralios A. C., Tsagaris T. J. Effect of activation sequence on MVO2 before and after coronary ligation. Am J Physiol. 1978 Mar;234(3):H260–H265. doi: 10.1152/ajpheart.1978.234.3.H260. [DOI] [PubMed] [Google Scholar]
  9. Kristensson B. E., Arnman K., Rydén L. Atrial synchronous ventricular pacing in ischaemic heart disease. Eur Heart J. 1983 Sep;4(9):668–673. doi: 10.1093/oxfordjournals.eurheartj.a061540. [DOI] [PubMed] [Google Scholar]
  10. Kruse I., Arnman K., Conradson T. B., Rydén L. A comparison of the acute and long-term hemodynamic effects of ventricular inhibited and atrial synchronous ventricular inhibited pacing. Circulation. 1982 May;65(5):846–855. doi: 10.1161/01.cir.65.5.846. [DOI] [PubMed] [Google Scholar]
  11. LaFarge C. G., Miettinen O. S. The estimation of oxygen consumption. Cardiovasc Res. 1970 Jan;4(1):23–30. doi: 10.1093/cvr/4.1.23. [DOI] [PubMed] [Google Scholar]
  12. Narahara K. A., Blettel M. L. Effect of rate on left ventricular volumes and ejection fraction during chronic ventricular pacing. Circulation. 1983 Feb;67(2):323–329. doi: 10.1161/01.cir.67.2.323. [DOI] [PubMed] [Google Scholar]
  13. Ono S., Nohara R., Kambara H., Okuda K., Kawai C. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation. 1992 Mar;85(3):1125–1131. doi: 10.1161/01.cir.85.3.1125. [DOI] [PubMed] [Google Scholar]
  14. Paraskevaidis I. A., Kremastinos D. T., Kassimatis A. S., Karavolias G. K., Kordosis G. D., Kyriakides Z. S., Toutouzas P. K. Increased response of diastolic blood pressure to exercise in patients with coronary artery disease: an index of latent ventricular dysfunction? Br Heart J. 1993 Jun;69(6):507–511. doi: 10.1136/hrt.69.6.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pehrsson S. K., Aström H. Left ventricular function after long-term treatment with ventricular inhibited compared to atrial triggered ventricular pacing. Acta Med Scand. 1983;214(4):295–304. doi: 10.1111/j.0954-6820.1983.tb10637.x. [DOI] [PubMed] [Google Scholar]
  16. Ritter P., Daubert C., Mabo P., Descaves C., Gouffault J. Haemodynamic benefit of a rate-adapted A-V delay in dual chamber pacing. Eur Heart J. 1989 Jul;10(7):637–646. doi: 10.1093/oxfordjournals.eurheartj.a059541. [DOI] [PubMed] [Google Scholar]
  17. Rosenqvist M., Isaaz K., Botvinick E. H., Dae M. W., Cockrell J., Abbott J. A., Schiller N. B., Griffin J. C. Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function. Am J Cardiol. 1991 Jan 15;67(2):148–156. doi: 10.1016/0002-9149(91)90437-p. [DOI] [PubMed] [Google Scholar]
  18. SOWTON E. HAEMODYNAMIC STUDIES IN PATIENTS WITH ARTIFICIAL PACEMAKERS. Br Heart J. 1964 Nov;26:737–746. doi: 10.1136/hrt.26.6.737. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Theodorakis G., Kremastinos D., Livanis M. M., Archontakis C., Karavolias G., Toutouzas P. c-AMP and ANP levels in VVI and DDD pacing with different AV delays during daily activity and exercise. Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1773–1778. doi: 10.1111/j.1540-8159.1990.tb06888.x. [DOI] [PubMed] [Google Scholar]

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