Preserving Normal Ventricular Activation Versus Atrioventricular Delay Optimization During Pacing: The Role of Intrinsic Atrioventricular Conduction and Pacing Rate

• Published in: Pacing and clinical electrophysiology Vol. 23; no. 1; pp. 74 - 83
• Main Authors: ILIEV, IVAN ILIEV, YAMACHIKA, SHIRO, MUTA, KEIZO, HAYANO, MOTONOBU, SHIISHIMATSU, TAKA, NAKAO, KOJIRO, KOMIYA, NORIHIRO, HIRATA, TETSUYA, UEYAMA, CHIAKI, YANO, KATSUSUKE
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2000
• Subjects: Aged; Aged, 80 and over; atrial pacing; Atrioventricular Node - physiopathology; Blood Flow Velocity; Cardiac Pacing, Artificial; dual chamber pacing; Echocardiography, Doppler; Female; first-degree A V block; Heart Block - diagnostic imaging; Heart Block - physiopathology; Heart Block - therapy; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; optimal A V delay; Treatment Outcome
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2000.tb00652.x

The purpose of the study was to compare the effects of DDD pacing with optimal AV delay and AAI pacing on the systolic and diastolic performance at rest in patients with prolonged intrinsic AV conduction (first‐degree AV block). We studied 17 patients (8 men, aged 69 ± 9 years) with dual chamber pacemakers implanted for sick sinus syndrome in 15 patients and paroxysmal high degree AV block in 2 patients. Aortic flow and mitral flow were evaluated using Doppler echocardiography. Study protocol included the determination of the optimal A V delay in the DDD mode and comparison between AAI and DDD with optimal A V delay for pacing rate 70/min and 90/min. Stimulus‐R interval during AAI (AHI) was 282 ± 68 ms for rate 70/min and 330 ± 98 ms for rate 90/min (P < 0.01). The optimal A V delay was 159 ± 22 ms, A V delay optimization resulted in an increase of an aortic flow time velocity integral (AFTVI) of 16%± 9%. At rate 70/min the patients with ARI ≤ 270 ms had higher AFTVI in AAI than in DDD (0.214 ± 0.05 m vs 0.196 ± 0.05 m, P < 0.01), while the patients with ARI > 270 ms demonstrated greater AFTVI under DDD compared to AAI(0.192 ± 0.03 m vs 0.166 ± 0.02 m, P < 0.01). At rate 90/min AFTVI was higher during DDD than AAI (0.183 ± 0.03 m vs 0.162 ± 0.03 m, P < 0.01). Mitral flow time velocity integral (MFTVI) at rate 70/min was higher in DDD than in AAI (0.189 ± 0.05 m vs 0.173 ± 0.05 mP < 0.01), while at rate 90/min the difference was not significant in favor of DDD (0.149 ± 0.05 m vs 0.158 ± 0.04 m). The results suggest that in patients with first‐degree AV block the relative impact of DDD and AAI pacing modes on the systolic performance depends on the intrinsic AV conduction time and on pacing rate.