Haemodynamic effects of dual-chamber pacing versus ventricular pacing during a walk test in patients with depressed or normal left ventricular function

  • Adele Ferro
  • Carlo Duilio
  • Maurizio Santomauro
  • Marco Salvatore
  • Alberto CuocoloEmail author
Original Article



Dual-chamber rate-modulated pacing provides haemodynamic benefits compared with ventricular pacing at rest, but it is unclear whether this also holds true during physical exercise in patients with heart failure. This study assessed the haemodynamic response to a walk test during dual-chamber pacing and ventricular pacing in patients with depressed or normal left ventricular (LV) function.


Twelve patients with an LV ejection fraction <50% and 11 patients with an LV ejection fraction ≥50% underwent two randomised 6-min walk tests under dual-chamber rate-modulated pacing and ventricular pacing at a fixed rate of 70 beats/min. All patients had a dual-chamber pacemaker implanted for complete heart block. LV function was monitored by a radionuclide ambulatory system.


In patients with depressed LV function, the change from dual-chamber pacing to ventricular pacing induced a decrease in end-systolic volume at the peak of the walk test (P<0.05), with no difference in end-diastolic volume. As a consequence, higher increases in LV ejection fraction (P<0.0001) and stroke volume (P<0.01) were observed during ventricular pacing. No difference in cardiac output was found between the two pacing modes. In patients with normal LV function, the change from dual-chamber pacing to ventricular pacing induced a significant decrease in cardiac output (P<0.005 at rest and P<0.05 at the peak of the walk test).


Compared with dual-chamber rate-modulated pacing, ventricular pacing improves cardiac function and does not affect cardiac output during physical activity in patients with depressed LV function, whereas it impairs cardiac output in those with normal function.


Dual-chamber pacing Ventricular pacing Left ventricular function Walk test 


  1. 1.
    Lamas GA, Orav EJ, Stambler BS, Ellenbogen KA, Sgarbossa EB, Huang SK, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. Pacemaker selection in the elderly investigators. N Engl J Med 1998;338:1097–104CrossRefPubMedGoogle Scholar
  2. 2.
    Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002;346:1854–62CrossRefPubMedGoogle Scholar
  3. 3.
    Janosik DL, Labovitz AJ. Basic physiology of cardiac pacing. In: Ellenbogen KA, Kay GN, Wilkoff BL, editors. Clinical cardiac pacing. Philadelphia PA: WB Saunders; 1995. p. 367–98Google Scholar
  4. 4.
    Sulke N, Chambers J, Dritsas A, Sowton E. A randomised double-blind crossover comparison of four rate-responsive pacing modes. J Am Coll Cardiol 1991;17:696–706PubMedGoogle Scholar
  5. 5.
    Sulke N, Dritsas A, Bostock J, Wells A, Morris R, Sowton E. “Subclinical” pacemaker syndrome: a randomised study of symptom-free patients with ventricular demand (VVI) pacemakers upgraded to dual-chamber devices. Br Heart J 1992;67:57–64PubMedGoogle Scholar
  6. 6.
    Kass DA. Pathophysiology of physiologic cardiac pacing. JAMA 2002;288:3159–61CrossRefPubMedGoogle Scholar
  7. 7.
    Kristensson BE, Arnman K, Ryden L. The haemodynamic importance of atrioventricular synchrony and rate increase at rest and during exercise. Eur Heart J 1985;6:773–78PubMedGoogle Scholar
  8. 8.
    Ferro A, Duilio C, Santomauro M, Cuocolo A. Walk test at increased levels of heart rate in patients with dual-chamber pacemaker and with normal or depressed left ventricular function. Eur Heart J 2003;24:2123–32CrossRefPubMedGoogle Scholar
  9. 9.
    Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implanted defibrillator. The dual chamber and VVI implantable defibrillator (DAVID) trial. JAMA 2002;288:3115–23CrossRefPubMedGoogle Scholar
  10. 10.
    Connolly SJ, Kerr CR, Gent M, Roberts RS, Yusuf S, Gillis AM, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. N Engl J Med 2000;342:1385–91CrossRefPubMedGoogle Scholar
  11. 11.
    Zaret BL, Jain D. Continuous monitoring of left ventricular function with miniaturized non-imaging detectors. In: Zaret BL, Beller GA, editors. Nuclear cardiology: state of the art and future directions. St. Louis: Mosby; 1999. p. 191–200Google Scholar
  12. 12.
    Tamaki N, Gill JB, Moore RH, Yasuda T, Boucher CA, Strauss HW. Cardiac response to daily activities and exercise in normal subjects assessed by an ambulatory ventricular function monitor. Am J Cardiol 1987;59:1164–69CrossRefPubMedGoogle Scholar
  13. 13.
    Tamaki N, Yasuda T, Moore RH, Gill JB, Boucher CA, Hutter AM Jr, et al. Continuous monitoring of left ventricular function by ambulatory radionuclide detector in patients with coronary artery disease. J Am Coll Cardiol 1988;12:669–79PubMedGoogle Scholar
  14. 14.
    Ferro A, Salvatore M, Cuocolo A. Radionuclide monitoring of left ventricular function after sublingual nifedipine administration at rest and during moderate physical activity. J Nucl Cardiol 2001;8:669–76CrossRefPubMedGoogle Scholar
  15. 15.
    Poole-Wilson PA. The 6-minute walk. A simple test with clinical application. Eur Heart J 2000;21:507–8CrossRefPubMedGoogle Scholar
  16. 16.
    Pace L, Cuocolo A, Nappi A, Nicolai E, Trimarco B, Salvatore M. Accuracy and repeatability of left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor. Eur J Nucl Med 1992;19:800–6CrossRefPubMedGoogle Scholar
  17. 17.
    Pace L, Cuocolo A, Stefano ML, Nappi A, Nicolai E, Imbriaco M, et al. Left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor: effects of different time averaging on accuracy. J Nucl Med 1993;34:1602–6PubMedGoogle Scholar
  18. 18.
    Imbriaco M, Cuocolo A, Pace L, Nappi A, Nicolai E, Maurea S, et al. Repeatability of haemodynamic responses to cardiac stimulations by ambulatory monitoring of left ventricular function. J Nucl Biol Med 1993;37:238–44Google Scholar
  19. 19.
    Heyndrickx GR, Vantrimpont PJ, Rousseau MF, Pouleur H. Effects of asynchrony on myocardial relaxation at rest and during exercise in conscious dogs. Am J Physiol 1988;254:H817–22PubMedGoogle Scholar
  20. 20.
    Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932–7CrossRefPubMedGoogle Scholar
  21. 21.
    Gallagher KP, Osakada G, Matsuzaki M, Kemper WS, Ross J Jr. Myocardial blood flow and function with critical coronary stenosis in exercising dogs. Am J Physiol 1982;12:H698–707Google Scholar
  22. 22.
    Ross J Jr. Myocardial perfusion-contraction matching. Implications for coronary heart disease and hibernation. Circulation 1991;83:1076–83PubMedGoogle Scholar
  23. 23.
    Scholl JM, Chaitman BR, David PR, Dupras G, Brevers G, Val PG, et al. Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty. Circulation 1982;66:380–90PubMedGoogle Scholar
  24. 24.
    Broderick T, Sawada S, Armstrong WF, Ryan T, Dillon JC, Bourdillon PD, et al. Improvement in rest and exercise-induced wall motion abnormalities after coronary angioplasty: an exercise echocardiographic study. J Am Coll Cardiol 1990;15:591–9PubMedGoogle Scholar
  25. 25.
    Lamas GA, Ellebogen KA. Evidence base for pacemaker mode selection. Circulation 2004;109:443–51CrossRefPubMedGoogle Scholar
  26. 26.
    Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, et al. Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Failure 2003;5:247–52CrossRefGoogle Scholar
  27. 27.
    Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI, et al. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. JAMA 1993;270:1702–7CrossRefPubMedGoogle Scholar
  28. 28.
    Demers C, McKelvie RS, Negassa A, Yusuf S. Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure. Am Heart J 2001;142:698–703CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Adele Ferro
    • 1
  • Carlo Duilio
    • 2
  • Maurizio Santomauro
    • 2
  • Marco Salvatore
    • 1
  • Alberto Cuocolo
    • 1
    Email author
  1. 1.Department of Biomorphological and Functional Sciences, Institute of Biostructure and Bioimages of the National Council of ResearchUniversity Federico IINaplesItaly
  2. 2.Department of Clinical Medicine, Cardiovascular and Immunological SciencesUniversity Federico IINaplesItaly

Personalised recommendations