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Cardiac Pacing pp 127-134 | Cite as

Deleterious Clinical and haemodynamic Effects of V-A Retroconduction in Symptomatic Sinus Bradyarrhythmias (S.S.B.) Treated with V. V. I. Pacing: their Regression with A. A. I. Pacing

  • G. Curzi
  • A. Purcaro
  • E. Molini
  • C. Viola
  • U. Berrettini
  • V. Di Luzio
Conference paper

Summary

Fifty-six pts. with “isolated” Symptomatic Sinus Brady-arrhythmias (S.S.B.) treated by V.V.I. p., showed 1:1 V-A retroconduction. They were followed for a mean period of 51 monts (12-122 m.). Twentynine pts. (52%) showed a progressive deterioration of cardiac function and c. heart failure. A high incidence of a. fibrillation (46%), thromboembolic complications (12.5%) and of syncopal episodes was also observed. Total survival was 80%, and 50% of deaths occurred within 2 years from PM implantation. Of the whole group 18 pts., who were not in A. F. were studied by L. and R. heart catheterization before and after 5 m’ of temporary A.A. I. pacing was instituted to a p. rate sufficient to inhibit the V. V.I. apparatus. Mean aortic pressure showed an increase(m.) of 20%, C. Index increased from a mean 2.6 (range 2.2-3.1) to 3.5 (3.2-4.0), mean P. wedge p. decreased from a mean of 17.8 mmHg (12-24) to 12 mmHg (9-14), R.A.P. from 13.7 (8-18) to 5.5 mmHg (3 - 7). These changes were all statistically significant. No statistically significant variations were seen for P.A.P., RVEDP and LVEDP. Permanent A.A.I. pacing was therefore instituted in all 18 pts.After a mean follow-up period of 2 yrs. survival is 100%, all pts. are still asymptomatic and no complications have occurred. The c1inical-haemodynamic deleterious effects due to V-A retroconduction (in pts. with S.S.B. and V.V.I. pms) are reversible using the A.A.I. mode of pacing which should be regarded as the treatment of choice for these conditions.

Keywords

Haemodynamic Effect Aortic Pressure Ventricular Pace Atrial Pace Mitral Valve Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Samet P, Castillo C and Bernstein WH: “Haemodynamic consequences of atrial and ventricular pacing in subjects with normal hearts”. Am J Cardiol 18; 522–525 (1966).CrossRefPubMedGoogle Scholar
  2. 2.
    Samet P, Bernstein WH, and Levine S: “Significance of the atrial contribution to ventricular filling” Am J Cardiol vol 15, 195–199 (1965).CrossRefPubMedGoogle Scholar
  3. 3.
    Benchimol A, Ellis JG, and Dimond E: “Hemodynamic consequences of atrial and ventricular pacing in patients with normal and abnormal hearts” Am J Med, vol 39, 911–918 (1965).CrossRefPubMedGoogle Scholar
  4. 4.
    Furman S: “Therapeutic uses of atrial pacing” Am Heart J, vol 86, 835–840 (1973).CrossRefPubMedGoogle Scholar
  5. 5.
    Gilmore JP, Sarnoff SI, Mitchell JH: “Synchronicity of ventricular contractions: observations comparing hemodynamic effects of atrial and ventricular pacing”. Br Heart J, vol 25, 299–305 (1963).CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Samet P, Castillo C, Bernstein WH: “Hemodynamic sequelae of atrial, ventricular, and sequential atrio-ventricular pacing in cardiac patients”. Am Heart J, vol 72, 725–729 (1966).CrossRefPubMedGoogle Scholar
  7. 7.
    Samet P, Bernstein WH, Levine S, and Lopez A: “Atrial contribution to cardiac output in complete heart block”. Am J Cardiol, Vol 16, 1–6 (1965).CrossRefPubMedGoogle Scholar
  8. 8.
    Amikam S, and Riss E: “Untoward hemodynamic consequences of permanent ventricular pacing associated with ventriculo-atrial conduction”. VIth World Symp. on Cardiac Pacing Montrea1 1979, Abstracts (n. 238).Google Scholar
  9. 9.
    Perrins J, and Sutton R: “Haemodynamic effects of atrial and ventricular pacing in sick sinus syndrome”. VIth World Symp on Cardiac Pacing Montreal, 1979, Abstracts (N 232).Google Scholar
  10. 10.
    Berkovits BV: “Hemodynamic consequences of at rio-ventricular and ventriculo-atrial pacing”. Pace, vol 1, 8–13 (1978).CrossRefPubMedGoogle Scholar
  11. 11.
    Haas JM, and Strait GB: “Pacemaker-induced cardiovascular failure: Hemodynamic and angiographic observations”. Am J Cardiol, Vol 33, 295–301 (1974).CrossRefPubMedGoogle Scholar
  12. 12.
    Patel AJ, and Thomsen JH: “A deleterious effect of cardiac pacing in a patient with mitral insufficiency”. Acta Med Scand, vol 202, 331–334 (1977).Google Scholar
  13. 13.
    Alicandri C, Fouad FM, Tarazi RC, Castle L, Morant V: “Three cases of hypotension and syncope with ventricular pacing: possible role of atrial reflexes”. Am J Cardiol, vol 42, 137–142 (1978).CrossRefPubMedGoogle Scholar
  14. 14.
    Ihara K, Sato S, Ogitani N, et al: “Evaluation of atrial pacing therapy for sick sinus syndrome. A comparison with ventricular pacing therapy”. VIth World Symp on Cardiac Pacing Montreal, 1979, Abstracts (N 263).Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1983

Authors and Affiliations

  • G. Curzi
    • 1
  • A. Purcaro
  • E. Molini
  • C. Viola
  • U. Berrettini
  • V. Di Luzio
    • 2
  1. 1.Ospedale Lancisi di AnconaAnconaItaly
  2. 2.Ospedale cardiologico “Lancisi”AnconaItaly

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