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
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.
KeywordsHaemodynamic Effect Aortic Pressure Ventricular Pace Atrial Pace Mitral Valve Disease
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- 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.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
- 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
- 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