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Related Experiment Videos

Left ventricular function in atrial fibrillation during overdrive pacing.

Viren Vankawala1, Bashar Markabawi, Sara Dainiak

  • 1Cardiology Division, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030-1305, USA.

American Heart Journal
|June 1, 2002
PubMed
Summary

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Ventricular pacing in atrial fibrillation (AF) improves stroke volume at faster rates by regularizing rhythm. However, cardiac output benefits were not observed at slower pacing rates, suggesting pacing must be in the upper physiologic range for efficacy.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Atrial fibrillation (AF) causes irregular heart rhythms, decreasing stroke volume and cardiac output.
  • Ventricular pacing after AV node ablation can improve left ventricular function.
  • Overdrive pacing was hypothesized to benefit cardiac performance in AF by regularizing rhythm.

Purpose of the Study:

  • To quantify the impact of ventricular pacing on stroke volume and cardiac output in patients with atrial fibrillation.
  • To assess if regularizing ventricular rhythm through pacing can mitigate the hemodynamic deficits of AF.

Main Methods:

  • Studied 18 patients with chronic AF and permanent pacemakers.
  • Measured aortic time velocity integral (TVI) via continuous-wave Doppler as a surrogate for stroke volume.

Related Experiment Videos

  • Compared stroke volume during AF with stroke volume during ventricular pacing at a fixed cycle length (666 ms) and minimum pacing rate.

    • Main Results:

    • Ventricular pacing at a cycle length of 666 ms significantly increased relative stroke volume by 18%.
    • No significant difference in cardiac output was found between pacing at the minimum rate and the corresponding AF cycle length.
    • Stroke volume improvements were observed only at pacing rates at or above the upper limit of the normal physiologic range.

    Conclusions:

    • Regularizing ventricular rhythm with overdrive pacing in AF patients can enhance stroke volume.
    • Cardiac output benefits from pacing in AF are contingent on pacing rates within or exceeding the normal physiologic range.
    • Pacing strategies should consider rate-dependent effects on hemodynamics in AF patients.