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Hemodynamic and symptomatic consequences of ventricular pacing
Pacing and Clinical Electrophysiology : PACE
|November 1, 1982
Summary
Ventriculoatrial conduction significantly impacts blood pressure during ventricular demand pacing (VVI). Intact conduction leads to greater blood pressure drops and increased risk of pacemaker syndrome, identified by symptoms like dizziness.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Pacemaker syndrome, characterized by dizziness and syncope, can occur despite VVI pacing.
- Understanding hemodynamic responses to pacing is crucial for patient management.
Purpose of the Study:
- To compare blood pressure responses to VVI pacing versus atrioventricular sequential pacing (DVI) or sinus rhythm.
- To identify predictors of adverse hemodynamic effects and symptoms in VVI pacing.
Main Methods:
- Fifty consecutive patients undergoing pacemaker implantation were studied.
- Cuff blood pressure was measured during VVI pacing, DVI pacing, and sinus rhythm.
- Patients were assessed for ventriculoatrial (VA) conduction and heart failure status.
Main Results:
- Patients with intact VA conduction experienced a significantly greater decrease in systolic blood pressure (24 mmHg) with VVI pacing compared to those with VA dissociation (-4 mmHg).
- Heart failure patients, often lacking VA conduction, showed a lesser blood pressure decrease during VVI pacing.
- Symptomatic dizziness occurred more frequently in patients with intact VA conduction (9/23) than without (1/27).
Conclusions:
- Intact ventriculoatrial conduction is a key determinant of hemodynamic response to VVI pacing.
- The presence of VA conduction identifies patients at higher risk for developing pacemaker syndrome.
- VVI pacing can have deleterious hemodynamic effects, particularly in patients with preserved VA conduction.