Difference in Mechanical Atrioventricular Delay Between Atrial Sensing and Atrial Pacing Modes in Patients with Hypertrophic and Dilated Cardiomyopathy: An Electrical Hemodynamic Catheterization Study

  • Yong-Mei Cha
  • Rick A. NishimuraEmail author
  • David L. Hayes


For optimal pacemaker programming in patients with cardiomyopathy, it is important to understand the relationship between the programmed right atrial and ventricular delay and the mechanical contraction delay of the left atrium and left ventricle. Methods: We analyzed data from 34 patients with dilated cardiomyopathy (14) or hypertrophic obstructive cardiomyopathy (20) who had dual-chamber Psynchronous pacing (VDD) and atrioventricular sequential pacing (DVI) during hemodynamic catheterization. Using multiple atrioventricular intervals during VDD and DVI pacing, the relationship of the programmed right atrial-right ventricular interval to the mechanical left atrial-left ventricular delay (assessed by high-fidelity pressures) was determined. Results: We found that the optimal mechanical left atrial-left ventricular delay was 120 ms, which required a programmed right atrial-right ventricular interval of 160 ms during DVI pacing. Also, the mean difference in right atrial-right ventricular pacing interval between VDD and DVI modes was 54±28 ms (range, 10–120 ms) in the hypertrophic obstructive cardiomyopathy group and 64±38 ms (range, 20–1 ± ms) in the dilated cardiomyopathy group. Conclusions: We concluded that the optimal right atrial-right ventricular interval during DVI pacing was 160 ms and that, to achieve the same mechanical left atrial-left ventricular delay, the programmed right atrial-right ventricular interval during VDD pacing was approximately ± ms to 60 ms shorter than during DVI pacing. However, the difference of electrical atrioventricular pacing interval in VDD and DVI may vary widely from patient to patient.

cardiac pacing artificial cardiomyopathy congestive cardiomyopathy hypertrophic heart catheterization 


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  1. 1.
    Nishimura RA, Hayes DL, Holmes DR Jr, Tajik AJ. Mechanism of hemodynamic improvement by dualchamber pacing for severe left ventricular dysfunction: an acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995;25:281–288.PubMedGoogle Scholar
  2. 2.
    Nishimura RA, Hayes DL, Ilstrup DM, Holmes DR Jr, Tajik AJ. Effect of dual-chamber pacing on systolic and diastolic function in patients with hypertrophic cardiomyopathy. Acute Doppler echocardiographic and catheterization hemodynamic study. J AmColl Cardiol 1996;27:421–430.Google Scholar
  3. 3.
    Nishimura RA, Symanski JD, Hurrell DG, Trusty JM, Hayes DL, Tajik AJ. Dual-chamber pacing for cardiomyopathies: a 1996 clinical perspective. Mayo Clin Proc 1996;71:1077–1087.PubMedGoogle Scholar
  4. 4.
    Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS. Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation 1999;99:2927–2933.PubMedGoogle Scholar
  5. 5.
    Hochleitner M, Hortnagl H, Fridrich L, Gschnitzer F. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy. Am J Cardiol 1992;70:1320–1325.PubMedGoogle Scholar
  6. 6.
    Fananapazir L, Epstein ND, Curiel RV, Panza JA, Tripodi D, McAreavey D. Long-term results of dualchamber (DDD) pacing in obstructive hypertrophic cardiomyopathy. Evidence for progressive symptomatic and hemodynamic improvement and reduction of left ventricular hypertrophy. Circulation 1994;90: 2731–2742.PubMedGoogle Scholar
  7. 7.
    Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, Nevo E. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567–1573.PubMedGoogle Scholar
  8. 8.
    Solomon AJ, Gersh BJ. Effect of recent randomized trials on current pacing practice. Cardiol Rev 1999;7: 9–16.PubMedGoogle Scholar
  9. 9.
    Braunwald E, Frahm C. Studies on Starling's lawof the heart. IV. Observations on the hemodynamic functions of the left atrium in man. Circulation 1961;24:633–642.Google Scholar
  10. 10.
    Gesell RA. Auricular systole and its relation to ventricular output. Am J Physiol 1911;29:32–63.Google Scholar
  11. 11.
    Skinner NS Jr, Mitchell JH, Wallace AG, Sarnoff SJ. Hemodynamic effects of altering the timing of atrial systole. Am J Physiol 1963;205:499–503. 140 Cha, Nishimura and Hayes PubMedGoogle Scholar
  12. 12.
    Nishimura RA, Schwartz RS, Tajik AJ, Holmes DR Jr. Noninvasive measurement of rate of left ventricular relaxation by Doppler echocardiography. Validation with simultaneous cardiac catheterization. Circulation 1993;88:146–155.PubMedGoogle Scholar
  13. 13.
    Nishimura RA, Schwartz RS, Holmes DR Jr, Tajik AJ. Failure of calcium channel blockers to improve ventricular relaxation in humans. J Am Coll Cardiol 1993;21:182–188.PubMedGoogle Scholar
  14. 14.
    Wiggers CJ, Katz LN. The contour of the ventricular volume curves under different conditions.AmJ Physiol 1922;58:439–475.Google Scholar
  15. 15.
    Brockman SK. Dynamic function of atrial contraction in regulation of cardiac performance. Am J Physiol 1963;204:597–603.PubMedGoogle Scholar
  16. 16.
    Little RC. Effect of atrial systole on ventricular pressure and closure of the A-V valves. Am J Physiol 1951;166:289–295.PubMedGoogle Scholar
  17. 17.
    Sarnoff SJ, Gilmore JP, Mitchell JH. Influence of atrial contraction and relaxation on closure of mitral valve. Observations on effects of autonomic nerve activity. Circulation Res 1962;11:26–35.PubMedGoogle Scholar
  18. 18.
    Wish M, Fletcher RD, Gottdiener JS, Cohen AI. Importance of left atrial timing in the programming of dual-chamber pacemakers. Am J Cardiol 1987;60: 566–571.PubMedGoogle Scholar
  19. 19.
    Wish M, Gottdiener JS, Cohen AI, Fletcher RD. M-mode echocardiograms for determination of optimal left atrial timing in patients with dual chamber pacemakers. Am J Cardiol 1988;61:317–322.PubMedGoogle Scholar
  20. 20.
    Pearson AC, Janosik DL, Redd RM, Buckingham TA, Labovitz AJ. Hemodynamic benefit of atrioventricular synchrony: prediction from baseline Dopplerechocardiographic variables. J Am Coll Cardiol 1989; 13:1613–1621.PubMedGoogle Scholar
  21. 21.
    Janosik DL, Pearson AC, Buckingham TA, Labovitz AJ, Redd RM. The hemodynamic benefit of differential atrioventricular delay intervals for sensed and paced atrial events during physiologic pacing. J Am Coll Cardiol 1989;14:499–507.PubMedGoogle Scholar
  22. 22.
    Hayes DL, Furman S. Atrio-ventricular and ventriculo-atrial conduction times in patients undergoing pacemaker implant. Pacing Clin Electrophysiol 1983;6: 38–46.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Yong-Mei Cha
    • 1
  • Rick A. Nishimura
    • 1
    Email author
  • David L. Hayes
    • 1
  1. 1.Division of Cardiovascular Diseases and Internal MedicineMayo ClinicRochesterUSA

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