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- Title
Optimizing the Hemodynamic Performance of the DDD Pacemaker: Impact of the Atrioventricular Delay on the Pulmonary Venous Flow Pattern.
- Authors
Douchet, M.-P.; Quiring, E.; Vi-Fane, R.; Bronner, F.; Messier, M.; Pasco, A.; Chauvin, M.; Wihlm, J.-M.; Brechenmacher, C.
- Abstract
This study evaluated the impact of the atrioventricular delay (AVD) on the pulmonary venous flow pattern (PVFP). Methods: Transthoracic Doppler PVFP were obtained during atrial and ventricular pacing at a fixed rate of 70 beats/min in 20 patients equipped with a DDD pacemaker, diastolic dysfunction linked to an impaired relaxation, a mean ejection fraction of 49%, and AV block. Two subgroups were analyzed equally: group I: seven patients with a normal ejection fraction and group II: 13 patients with decreased ejection fraction. Three different AVDs were studied: short (50 ms), intermediate (150 ms), and long (250 ms). Results: As the AVD increased, the diastolic filling time and the peak atrial reverse flow wave decreased (P < 0.001). There was a decreasing D wave and no significant change in the peak velocity of the S wave. The S wave became biphasic in all patients at the longest AVD of 250 ms. The systolic (S) velocity time integral (VTI) of the pulmonary wave and the systolic/total PVF-VTI ratio increased significantly (P < 0.001). A similar response was seen in both group of patients. Conclusions: These data correlated the AVD with PVFP, supplying critical systolic information completing the diastolic data obtained from mitral Doppler patterns. These systolic measurements were especially useful for patients with heart failure and a DDD pacemaker, in order to obtain the longest diastolic filling time at the lowest atrial pressure.
- Subjects
CARDIAC pacemakers; HEART conduction system; HEMODYNAMICS; CARDIAC pacing; IMPLANTED cardiovascular instruments; HEART diseases; HEART failure
- Publication
Pacing & Clinical Electrophysiology, 1998, Vol 21, Issue 11, p2261
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/j.1540-8159.1998.tb01164.x