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J Am Coll Cardiol, 2000; 35:1453-1461
© 2000 by the American College of Cardiology Foundation
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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

Jens Cosedis Nielsen, MDa, Morten Bøttcher, MDa, Torsten Toftegaard Nielsen, MD, DMSca, Anders Kirstein Pedersen, MD, DMSca and Henning Rud Andersen, MD, DMSca

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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