Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1995 Oct;74(4):403–407. doi: 10.1136/hrt.74.4.403

Atrial electromechanical sequence in normal subjects and patients with DDD pacemakers.

K Wang 1, H B Xiao 1, S Fujimoto 1, D G Gibson 1
PMCID: PMC484047  PMID: 7488455

Abstract

OBJECTIVE--To assess the effect of right atrial appendage pacing on atrial electromechanical interrelations in patients with DDD pacemakers. DESIGN--Prospective study by M mode echocardiogram, Doppler echocardiogram, and apexcardiogram, along with electrocardiogram and phonocardiogram. SETTING--Tertiary cardiac referral centre. PATIENTS--20 patients with DDD pacemakers and 20 age matched normal controls. RESULTS--Age, RR interval, atrial size, left ventricular size, and fractional shortening were similar in the two groups. Atrial electromechanical delay (the time from the onset of P wave or atrial pacing spike on ECG to the onset of atrial contraction on M mode echogram) was 68 (SD 7) ms at the lateral site of right atrium, 82 (9) ms at the central fibrous body, 93 (11) ms at the lateral site of left atrium in normals. In patients with DDD pacing, however, this delay increased to 85 (22) ms, 117 (23) ms, and 138 (25) ms respectively (all P < 0.01). Interatrial mechanical delay (the time from the onset of right atrial motion to the onset of the left) increased from 25 (6) ms in normal controls to 53 (18) ms in patients (P < 0.01). Intra-atrial mechanical dispersion (the time from the earliest to the latest onset of regional atrial motion around the atrioventricular ring) in the right atrium increased from 6 (2) ms in normals to 19 (2) ms in patients (P < 0.01), but it remained unchanged in the left atrium (6 (2) ms in normal controls v 7 (2) ms in patients, P > 0.05). Peak atrial shortening rate was not different between the two groups. Differences of atrial electromechanical activity between the two groups were also reflected on Doppler echocardiogram and apexcardiogram. CONCLUSIONS--Right atrial appendage pacing disturbs the normal coordinate sequence of right atrial mechanical activity and leads to a striking and variable increase in intra-atrial conduction time as well as in interatrial conduction time. Left atrial contraction remains synchronous although the timing of the start of its contraction was delayed. These values can be determined in individual patients to allow optimal setting of DDD pacemakers.

Full text

PDF
403

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abe H., Yokouchi M., Deguchi F., Saitoh F., Yoshimi H., Arakaki Y., Natsume T., Kawano Y., Yoshida K., Kuramochi M. Measurement of left atrial systolic time intervals in hypertensive patients using Doppler echocardiography: relation to fourth heart sound and left ventricular wall thickness. J Am Coll Cardiol. 1988 Apr;11(4):800–805. doi: 10.1016/0735-1097(88)90214-8. [DOI] [PubMed] [Google Scholar]
  2. Anderson R. H., Becker A. E., Tranum-Jensen J., Janse M. J. Anatomico-electrophysiological correlations in the conduction system--a review. Br Heart J. 1981 Jan;45(1):67–82. doi: 10.1136/hrt.45.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ausubel K., Klementowicz P., Furman S. Interatrial conduction during cardiac pacing. Pacing Clin Electrophysiol. 1986 Nov;9(6 Pt 2):1026–1031. doi: 10.1111/j.1540-8159.1986.tb06665.x. [DOI] [PubMed] [Google Scholar]
  4. BRAUNWALD E., FISHMAN A. P., COURNAND A. Time relationship of dynamic events in the cardiac chambers, pulmonary artery and aorta in man. Circ Res. 1956 Jan;4(1):100–107. doi: 10.1161/01.res.4.1.100. [DOI] [PubMed] [Google Scholar]
  5. Camous J. P., Raybaud F., Dolisi C., Schenowitz A., Varenne A., Baudouy M. Interatrial conduction in patients undergoing AV stimulation: effects of increasing right atrial stimulation rate. Pacing Clin Electrophysiol. 1993 Nov;16(11):2082–2086. doi: 10.1111/j.1540-8159.1993.tb01010.x. [DOI] [PubMed] [Google Scholar]
  6. Forfang K., Otterstad J. E., Ihlen H. Optimal atrioventricular delay in physiological pacing determined by Doppler echocardiography. Pacing Clin Electrophysiol. 1986 Jan;9(1 Pt 1):17–20. doi: 10.1111/j.1540-8159.1986.tb05356.x. [DOI] [PubMed] [Google Scholar]
  7. Gibson D. G., Brown D. Measurement of instantaneous left ventricular dimension and filling rate in man, using echocardiography. Br Heart J. 1973 Nov;35(11):1141–1149. doi: 10.1136/hrt.35.11.1141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Iwase M., Sotobata I., Yokota M., Takagi S., Jing H. X., Kawai N., Hayashi H., Murase M. Evaluation by pulsed Doppler echocardiography of the atrial contribution to left ventricular filling in patients with DDD pacemakers. Am J Cardiol. 1986 Jul 1;58(1):104–109. doi: 10.1016/0002-9149(86)90251-1. [DOI] [PubMed] [Google Scholar]
  9. Janse M. K., Anderson R. H., van Capelle F. J., Durrer D. A combined electrophysiological and anatomical study of the human fetal heart. Am Heart J. 1976 May;91(5):556–562. doi: 10.1016/s0002-8703(76)80139-1. [DOI] [PubMed] [Google Scholar]
  10. Jones C. J., Song G. J., Gibson D. G. An echocardiographic assessment of atrial mechanical behaviour. Br Heart J. 1991 Jan;65(1):31–36. doi: 10.1136/hrt.65.1.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Josephson M. E., Scharf D. L., Kastor J. A., Kitchen J. G. Atrial endocardial activation in man. Electrode catheter technique of endocardial mapping. Am J Cardiol. 1977 Jun;39(7):972–981. doi: 10.1016/s0002-9149(77)80210-5. [DOI] [PubMed] [Google Scholar]
  12. Leier C. V., Jewell G. M., Magorien R. D., Wepsic R. A., Schaal S. F. Interatrial conduction (activation) times. Am J Cardiol. 1979 Sep;44(3):442–446. doi: 10.1016/0002-9149(79)90394-1. [DOI] [PubMed] [Google Scholar]
  13. Spach M. S., King T. D., Barr R. C., Boaz D. E., Morrow M. N., Herman-Giddens S. Electrical potential distribution surrounding the atria during depolarization and repolarization in the dog. Circ Res. 1969 Jun;24(6):857–873. doi: 10.1161/01.res.24.6.857. [DOI] [PubMed] [Google Scholar]
  14. Spach M. S., Lieberman M., Scott J. G., Barr R. C., Johnson E. A., Kootsey J. M. Excitation sequences of the atrial septum and the AV node in isolated hearts of the dog and rabbit. Circ Res. 1971 Aug;29(2):156–172. doi: 10.1161/01.res.29.2.156. [DOI] [PubMed] [Google Scholar]
  15. Sutton R., Perrins J., Citron P. Physiological cardiac pacing. Pacing Clin Electrophysiol. 1980 Mar;3(2):207–219. doi: 10.1111/j.1540-8159.1980.tb04331.x. [DOI] [PubMed] [Google Scholar]
  16. Wang K., Ho S. Y., Gibson D. G., Anderson R. H. Architecture of atrial musculature in humans. Br Heart J. 1995 Jun;73(6):559–565. doi: 10.1136/hrt.73.6.559. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES