Digital pulse volume in the evaluation of haemodynamic effects of cardiac pacing

Some artificially paced patients experience symptoms referrable to competition between spontaneous and pacemaker-induced heart activity. Haemodynamic studies are necessary to establish a relationship. Non-invasive techniques are desirable. Because of the considerable variations in haemodynamic variables from one beat to another it seems necessary to do beat-to-beat analysis. In the present study a comparison has been made between digital arterial pulse amplitude (DAPA) and central haemodynamic parameters in six patients at different pacing modes. A good correlation was found between DAPA and arterial pulse pressure (r = 0.83-0.99). The mean difference in cardiac output between atrio-ventricular pacing and ventricular pacing with atrial activation in early systole was 1.11 /min (P less than 0.01). A mean increase of 70% in DAPA was found at optimal PR-time as compared to simultaneous atrial and ventricular activation; wide individual variations were, however, seen. The results presented indicate that peripheral pulse volume registrations may be helpful in evaluating the consequences of atrial contractions for haemodynamic variables and to find those paced who may benefit from atrial or bifocal heart stimulation.