CLINICAL RESEARCH: HEART RHYTHM DISORDER
Acute Hemodynamic Benefits of Bi-Atrial Atrioventricular Sequential Pacing With the Optimal Atrioventricular Delay
Atsushi Doi, MD,
Masahiko Takagi, MD*,
Iku Toda, MD,
Minoru Yoshiyama, MD,
Kazuhide Takeuchi, MD and
Junichi Yoshikawa, MD, FACC
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Manuscript received November 13, 2004;
revised manuscript received April 11, 2005,
accepted April 14, 2005.
* Reprint requests and correspondence: Dr. Masahiko Takagi, Department of Internal Medicine of Cardiology, Osaka City University Graduate School Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. (Email: m7424580{at}msic.med.osaka-cu.ac.jp).
OBJECTIVES: We evaluate the acute effects on hemodynamics of bi-atrial (BiA) pacing with the optimal atrioventricular (AV) delays, in comparison with high right atrial (HRA) pacing and coronary sinus (CS) pacing.
BACKGROUND: Bi-atrial pacing has been suggested as one of the alternative therapy for preventing the recurrence of atrial fibrillation (AF). There are, however, few reports on the hemodynamic effects of BiA pacing, and the results that exist are controversial.
METHODS: Twenty patients were paced from HRA, left lateral site of CS, and both sites with the optimal AV delays at 80 and 100 beats/min, in random order. After 5-min pacing, maximal P-wave duration in a 12-lead electrocardiogram, cardiac output (CO), pulmonary capillary wedge pressure (PCWP), and the transmitral flow pattern by transthoracic echocardiography were measured.
RESULTS: Compared with HRA and CS pacing, BiA pacing delivered the shortest P-wave duration (HRA: 130 ± 14 ms, CS: 132 ± 19 ms, and BiA: 94 ± 8 ms, respectively, p < 0.001) and the most improvement in CO and PCWP (HRA: 3.63 ± 0.67 l/min and 9.2 ± 4.3 mm Hg, CS: 3.71 ± 0.70 l/min and 8.8 ± 3.4 mm Hg, and BiA: 3.88 ± 0.63 l/min and 8.0 ± 3.1 mm Hg, respectively, p < 0.01). Bi-atrial pacing also significantly increased the mitral flow time velocity integral and peak A-wave velocity by transthoracic echocardiography, compared with HRA and CS pacing (HRA: 7.6 ± 1.4 cm and 68.8 ± 12.2 cm/s, CS: 7.8 ± 1.4 cm and 70.5 ± 14.5 cm/s, and BiA: 8.2 ± 1.2 cm and 76.3 ± 14.2 cm/s, respectively, p < 0.01). Bi-atrial pacing most significantly decreased the intervals between the atrial pacing spike and the peak of A-wave (HRA: 180 ± 28 ms, CS: 165 ± 21 ms, and BiA: 157 ± 19 ms, respectively, p < 0.01). These improvements in hemodynamics significantly correlated with interatrial conduction delay.
CONCLUSIONS: Bi-atrial pacing made the most significant improvements of hemodynamics. These benefits may be due to the improvements in interatrial conduction delay and atrial dyssynchrony.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | AV = atrioventricular | | A Vmax = peak velocity of the atrial filling wave | | BiA = bi-atrial | | CS = coronary sinus | | ECG = electrocardiogram | | E Vmax = peak velocity of the early filling wave | | HRA = high right atrial or atrium | | Max CD = maximal interatrial conduction delay | | PCWP = pulmonary capillary wedge pressure | | S-A peak = the interval from the atrial pacing spike on the ECG to the peak of the atrial filling wave | | SBP = systolic blood pressure | | TVI = the mitral flow time velocity integral |
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