Heart and Vessels

, Volume 23, Issue 6, pp 403–408

Usefulness of rate regulation through continuous ventricular pacing in patients with drug-controlled slower atrial fibrillation and normal or depressed left ventricular systolic function

  • John Chiladakis
  • Nikolaos Koutsogiannis
  • Andreas Kalogeropoulos
  • Fani Zagli
  • Panagiotis Arvanitis
  • Dimitrios Alexopoulos
Original Article

Abstract

We studied 33 clinically stable patients with permanent atrial fibrillation (AF), implanted with a ventricular demand rate-responsive (VVIR) pacemaker or an automatic defibrillator, in order to evaluate whether continuous right ventricular apex pacing (VP) conferring rate regulation may be advantageous when compared with slower drug-controlled AF. Devices were chronically programmed at ventricular backup pacing. Patients were divided in two groups according to their normal (n = 17) or depressed (n = 16) left ventricular systolic function (LVSF). Ventricular function was studied by using tissue Doppler and color M-mode and echocardiography, as well as B-type natriuretic peptide (BNP) measurements. Baseline data during AF were compared to corresponding measurements following a 1-month pacing period after the devices were programmed at a base rate of 70 beats/min. In both groups, VP worsened some indexes of left and right ventricular function (P < 0.05) without significantly affecting cardiac output, left ventricular filling pressures and BNP (P = not significant). We conclude that VP should not be considered advantageous compared to slower AF.

Key words

Atrial fibrillation Ventricular pacing Ventricular function 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lau CP, Leung WH, Wong CK, Cheng CH (1990) Haemodynamics of induced atrial fibrillation: a comparative assessment with sinus rhythm, atrial and ventricular pacing. Eur Heart J 11: 219–224PubMedGoogle Scholar
  2. 2.
    Daoud EG, Weiss R, Bahu M, Knight BP, Bogum F, Goyal R, Harvey M, Strickberger SA, Man KC, Morady F (1996) Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol 78:1433–1436PubMedCrossRefGoogle Scholar
  3. 3.
    Prabhu SD (2007) Altered left ventricular-arterial coupling precedes pump dysfunction in early heart failure. Heart Vessels 22:170–177PubMedCrossRefGoogle Scholar
  4. 4.
    Hohnloser SH, Kuck K-H, Lillenthal J, for the PIAF Investigators (2000) Rhythm or rate control in atrial fibrillation — Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet 56:1789–1794CrossRefGoogle Scholar
  5. 5.
    The Atrial Fibrillation Follow-up Investigation on Rhythm Management (AFFIRM) Investigators (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833CrossRefGoogle Scholar
  6. 6.
    Kosior DA, Szulc M, Opolski G, Torbicki A, Rabczenko D (2006) Long-term sinus rhythm maintenance after cardioversion of persistent atrial fibrillation: is the treatment success predictable? Heart Vessels 21:375–381PubMedCrossRefGoogle Scholar
  7. 7.
    Tops LF, Schalij MJ, Holman ER, van Erven L, van der Wall EE, Bax JJ (2006) Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am Coll Cardiol 48:1642PubMedCrossRefGoogle Scholar
  8. 8.
    Levy T, Walker S, Mason M, Spurrell P, Rex S, Brant S, Paul V (2001) Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomized controlled study. Heart 85:171–178PubMedCrossRefGoogle Scholar
  9. 9.
    Lau C-P, Jiang Z-Y, Tang M-O (1998). Efficacy of ventricular rate stabilization by right ventricular pacing during atrial fibrillation. Pacing Clin Electrophysiol 21:542–548PubMedCrossRefGoogle Scholar
  10. 10.
    Simpson CS, Yee R, Lee JK, Braney M, Klein GJ, Krahn AD, Skanes AC (2001) Safety and feasibility of a novel rate-smoothing ventricular pacing algorithm for atrial fibrillation. Am Heart J 142:294–300PubMedCrossRefGoogle Scholar
  11. 11.
    ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation. J Am Coll Cardiol 48:149–246CrossRefGoogle Scholar
  12. 12.
    Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA (2003) 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 107:2932–2937PubMedCrossRefGoogle Scholar
  13. 13.
    Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A (2002) Dual Chamber and VVI Implantable Defibrillator Trial Investigators. Dual Chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 288:3115–3123PubMedCrossRefGoogle Scholar
  14. 14.
    Tse HF, Lau CP (1977) Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 29: 744–749CrossRefGoogle Scholar
  15. 15.
    De Lemos JA, McGuire DK, Drazner MH (2003) B-type natriuretic peptide in cardiovascular disease. Lancet 362:316–322PubMedCrossRefGoogle Scholar
  16. 16.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Steward W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108PubMedCrossRefGoogle Scholar
  17. 17.
    Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goval RG, Gatewood RP Jr (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 5:175–183Google Scholar
  18. 18.
    Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF (2003) Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 91:780–784PubMedCrossRefGoogle Scholar
  19. 19.
    Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG, Kim HC (1999) Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr 12:927–931PubMedCrossRefGoogle Scholar
  20. 20.
    Meluzin J, Spinarova L, Dusek L, Toman J, Hude P, Krejci J (2003) Prognostic importance of right ventricular function assessed by Doppler tissue imaging. Eur J Echocardiogr 4:262–271PubMedCrossRefGoogle Scholar
  21. 21.
    Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings Am J Cardiol 57:450–458PubMedCrossRefGoogle Scholar
  22. 22.
    Vankawala V, Markabawi B, Dainiak S, Werner M, Hager WD, Farrel W, Katz AM, Silverman DI (2002) Left ventricular function in atrial fibrillation during overdrive pacing Am Heart J 143: 827–832PubMedCrossRefGoogle Scholar
  23. 23.
    Gosselink AT, Blanksma PK, Crijns HJ, Van Gelder IC, de Kam PJ, Hillege HL, Niemeijer MG, Lie KI, Meijler FL(1995) Left ventricular beat-to-beat performance in atrial fibrillation: contribution of Frank-Starling mechanism after short rather than long RR intervals. J Am Coll Cardiol 26:1516–1521PubMedCrossRefGoogle Scholar
  24. 24.
    Zhuang S, Zhang Y, Mowrey KA, Li J, Tabata T, Wallick DW, Popovic ZB, Grimm RA, Natale A, Mazgalev TN (2002) Ventricular rate control by selective vagal stimulation is superior to rhythm regularization by atrioventricular nodal ablation and pacing during atrial fibrillation. Circulation 106:1853–1858PubMedCrossRefGoogle Scholar
  25. 25.
    Li J, Wang L (2006) B-type natriuretic peptide levels in patients with paroxysmal lone atrial fibrillation. Heart Vessels 21:137–140PubMedCrossRefGoogle Scholar
  26. 26.
    Lubien E, De Maria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, Gardetto N, Wanner E, Maisel AS (2002) Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 105:595–601PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • John Chiladakis
    • 1
    • 2
  • Nikolaos Koutsogiannis
    • 1
  • Andreas Kalogeropoulos
    • 1
  • Fani Zagli
    • 1
  • Panagiotis Arvanitis
    • 1
  • Dimitrios Alexopoulos
    • 1
  1. 1.Cardiology DepartmentUniversity Hospital of PatrasRion, PatrasGreece
  2. 2.PatrasGreece

Personalised recommendations