[Effects of heart rate on body surface potential distribution in patients with atrial pacemaker]

Nine patients of sick sinus syndrome with atrial programmable pacemaker (3 males and 6 females, aged from 53 to 72 years) were studied to assess the effect of heart rate on the body surface potential distribution. Body surface maps (87 lead points) and M-mode echocardiograms were recorded at 20-beat increments of heart rate from 60 to 140 beats/min during atrial pacing. The potential changes of R and S voltages were evaluated quantitatively and were correlated with the changes of echocardiographically measured left ventricular dimension. As the heart rate increased, left ventricular dimension in end-diastole (LVDd) decreased gradually (Table 1), and a significant decrease was observed when the heart rate increased from 80 to 100 beats/min and from 100 to 120 beats/min, respectively, (p less than 0.05). With a decrease in LVDd, the distance between the left ventricular posterior wall and the anterior chest wall decreased and the left ventricular wall increased in its thickness. These changes, however, were not statistically significant. With an increase in the heart rate, R voltages decreased gradually in the left lateral chest and the sum of R voltages (sigma R) of six lead points in the left lateral chest including leads V5-6 decreased significantly when the heart rate increased from 60 to 100 beats/min and from 80 to 120 beats/min, respectively (p less than 0.02) (Table 2). On the other hand, R voltages remained unchanged in the left anterior chest during atrial pacing, then the sum of R voltages of six lead points in the left anterior chest including leads V2-4 and the sum of R voltages of 87 lead points did not show any significant changes (Table 2). An increase in the absolute value of S voltages was observed in the left anterior chest and the sum of S voltages of six lead points in the left anterior chest including leads V2-4 increased when the heart rate increased from 60 to 100 beats/min and from 80 to 120 beats/min, respectively (p less than 0.1) (Table 3) A decrease of R voltages in the left lateral chest was consistent with the reduction in LVDd (p less than 0.005). It is concluded that the changes in body surface QRS amplitudes during atrial pacing are related to those in the left ventricular dimension and that R voltages in the left lateral chest are fairly sensitive to see the changes in LVDd in cases with no abnormal wall motion of the left ventricle.(ABSTRACT TRUNCATED AT 400 WORDS)