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CLINICAL STUDIES

Regional myocardial blood flow in patients with sick sinus syndrome randomized to long-term single chamber atrial or dual chamber pacing—effect of pacing mode and rate

^a Department of Cardiology B, Skejby Sygehus, Aarhus University Hospital, Brendstrupgaardsvej, 8200-DK, Aarhus N, Denmark

Manuscript received September 7, 1999; revised manuscript received December 3, 1999, accepted January 17, 2000.

Reprint requests and correspondence: Dr. Henning Rud Andersen, Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Brendstrupgaardsvej, 8200-DK, Aarhus N, Denmark
skejhra{at}aau.dk

OBJECTIVES

This study aimed to evaluate regional myocardial blood flow (MBF) and global left ventricular ejection fraction (LVEF) during chronic pacing in patients with sick sinus syndrome (SSS) randomized to either single chamber atrial (AAI) or dual chamber (DDD) pacing.

BACKGROUND

Experimental studies indicate that chronic pacing in the right ventricular apex changes regional MBF, thereby compromising left ventricular function.

METHODS

Thirty patients (age 74 ± 10 years) were randomized to AAI (n = 15) or DDD (n = 15) pacemakers. After 22 ± 7 months of pacing, MBF was quantified with ¹³N-labeled ammonia positron emission tomography scanning at 60 beats per min and 90 beats per min. Patients in the DDD group furthermore underwent MBF measurement at temporary AAI pacing, 60 beats per min. Myocardial blood flow was assessed in the anterior, lateral, inferior and septal regions, and the global mean MBF was calculated. Left ventricular ejection fraction was determined by echocardiography at pacemaker implantation and at the time of MBF measurements.

RESULTS

Myocardial blood flow at rates 60 and 90 beats per min did not differ between the AAI and DDD groups. During temporary AAI pacing in the DDD group, MBF was significantly higher than during DDD pacing in both the inferior (p = 0.001) and septal (p = 0.004) regions and also globally (0.61 ± 0.15 vs. 0.53 ± 0.13 mL·g^–1·min^–1, p = 0.005). In the DDD group, LVEF decreased from pacemaker implantation to time of MBF measurements (0.61 ± 0.09 vs. 0.56 ± 0.07, p = 0.013). Left ventricular ejection fraction during temporary AAI pacing at time of MBF measurements was not different from LVEF at pacemaker implantation.

CONCLUSIONS

In patients with SSS, chronic DDD pacing reduced inferior, septal and global mean MBF as well as LVEF, as compared with temporary AAI pacing. The LVEF reversed to baseline level during temporary AAI pacing despite 22 months of permanent ventricular pacing preceding it. Augmenting pace rate to 90 beats per min increased MBF equally in the two treatment groups.

Abbreviations and Acronyms   AAI = single chamber atrial pacing   AAIR = rate responsive single chamber atrial pacing   AV = atrioventricular   DDD = dual chamber pacing   DDDR = rate responsive dual chamber pacing   ECG = electrocardiogram   LAD = left anterior descending artery   LCX = left circumflex artery   LVEF = left ventricular ejection fraction   MBF = myocardial blood flow   PET = positron emission tomography   RCA = right coronary artery   ROI = region of interest   RPP = rate pressure product   SD = standard deviation   SSS = sick sinus syndrome   VVI = single chamber ventricular pacing

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