Is Rate-Adaptive Ventricular Pacing Already Obsolete?

  • M. Rosenquist
  • C. Edelstam
  • R. Nordlander
Conference paper


Pacing from the right ventricular apex was first introduced into clinical practice in 1958. Since then, a tremendous technological development has been introduced, leading to the use of more physiological pacing systems including single pacing units with rate-responsive function and atrial synchronous pacing systems with or without rate-responsive mode.


Ventricular Pace Atrial Pace Cardiac Pace Sick Sinus Syndrome Pace System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Park RC, Little WC, O’Rourke RA (1985) Effect of alteration of left ventricular activaton sequence on the left ventricular end systolic pressure-volume relationship in closed-chest dogs. Circ Res 57:706–717PubMedGoogle Scholar
  2. 2.
    Rosenqvist M, Isaac K, Botvinick EH, Dae MW, Cockrell J, Abott JA, Schiller NB, Griffin JC (1991) Relative importance of activation sequence compared to AV synchrony in left ventricular function. Am J Cardiol 67:148–156PubMedCrossRefGoogle Scholar
  3. 3.
    Karpawich PP, Chang CH, Kukus LR, Justice CD (1991) Initial histologic comparison between apical and a new septal ventricular pacing method in immature canines. PACE 67:148–156Google Scholar
  4. 4.
    Ryden L, Karlsson O, Kristensson BE (1988) The importance of different atrioventricular intervals for exercise capacity. PACE 11:1051–1062PubMedGoogle Scholar
  5. 5.
    Mehta D, Gilmour S, Ward DE, Camm AJ (1989) Optimal atrioventricular delay at rest and during exercise in patients with dual chamber pacemakers. Br Heart J 61:161–166PubMedCrossRefGoogle Scholar
  6. 6.
    Haskell RJ, French WJ (1989) Physiological importance of different atrioventricular intervals to improved exercise performance in patients with dual chamber pacemakers. Br Heart J 61:46–51PubMedCrossRefGoogle Scholar
  7. 7.
    Ritter P, Daubert C, Mabo P, Descaves C, Gouffault J (1989) Hemodynamic benefit of a rate adapted AV delay in dual chamber pacing. Eur Heart J 7:637–647Google Scholar
  8. 8.
    Eugene M, Lascault G, Frank R, Fontaine G, Grosgogeat Y, Teillac A (1989) Assessment of the optimal atrioventricular delay in DDD paced patients by impedance pletysmography. Eur Heart J 3:250–256Google Scholar
  9. 9.
    Landzberg JS, Franklin JO, Mahawar SK, Himelman RB (1990) Benefits of atrioventricular synchronization for pacing with an exercise rate response. Am J Cardiol 66:193–197PubMedCrossRefGoogle Scholar
  10. 10.
    Sulke N, Pilips A, Henderson RA, Bucknall CA, Sowton E (1990) Comparison of the normal sinus node with seven types of rate responsive pacemaker during everyday activity. Br Heart J 64:25–31PubMedCrossRefGoogle Scholar
  11. 11.
    Feruglio GA, Richards AF, Steinbach K, Feldman S, (1987) Cardiac pacing in the world. A survey of the state of the art. PACE 10:768–777Google Scholar
  12. 12.
    Parsonnet V, Bernstein AD, Galasso D (1988) Cardiac pacing practices in the United States 1985. Am J Cardiol 62:71–77PubMedCrossRefGoogle Scholar
  13. 13.
    Shaw DB, Holman RR, Gowers JI (1980) Survival in sinoatrial disease. Br Med J 280:139–134PubMedCrossRefGoogle Scholar
  14. 14.
    Wirtzfeld A, Schmidt G, Klein G, Worzewski W (1981) Long-term effect of atrial pacing in patients with sick sinus syndrome. PACE 4:A77Google Scholar
  15. 15.
    Stone JM, Bhakta RD, Lütgen J (1982) Dual chamber sequential pacing management of sinus node disease dysfunction. Advantages over single chamber pacing. Am Heart J 104:1319Google Scholar
  16. 16.
    Sutton R, Kenny RA (1986) The natural history of sinus node disease. PACE 9 /11:1110–1114PubMedGoogle Scholar
  17. 17.
    Rosenqvist M, Brandt J, Schüller H (1988) Long-term pacing in sinus node disease. Effects of stimulation mode in cardiovascular morbidity and mortality. Am Heart J 116:16–22PubMedCrossRefGoogle Scholar
  18. 18.
    Sasaki Y, Shimotori M, Akahane K, Yonekura H, Hirano K, Endoh R, Koike S, Kawa S, Furuta S, Homma T (1988) Long-term follow-up of patients with sick sinus syndrome:comparison of clinical aspects among unpaced, ventricular inhibited paced, and physiological paced groups. PACE 11:1575–1583PubMedGoogle Scholar
  19. 19.
    Bianconi L, Boccadamo R, Di Florio A, Carpino A, Catalano A, Stella C, Distolese H (1989) Is Rate-Adaptive Ventricular Pacing Already Obsolete? 233 Atrial versus ventricular stimulation in sick sinus syndrome:effects on morbidity and mortality. PACE 12:1236Google Scholar
  20. 20.
    Santini M, Alexidou G, Ansalone G, Cacciatore G, Cini R, Turitto G (1990) Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 65:729–735PubMedCrossRefGoogle Scholar
  21. 21.
    Kallryd A (1990) Atrial versus ventricular pacing in sinus node disease. Clinical experience. Presented at the 6th Nordic symposium on cardiac pacing, ÄrhusGoogle Scholar
  22. 22.
    Denjoy I, Leclerq JF, Druelles P, Daubert C, Coumel P (1989) Comparative efficacy of permanent atrial pacing in vagal atrial arrhythmias and in bradycardia-tachycardia syndrome. PACE 12:1236Google Scholar
  23. 23.
    Rosenqvist M, (1990) Atrial pacing for sick sinus syndrome. Clin Cardiol 13:43–47PubMedCrossRefGoogle Scholar
  24. 24.
    Kallryd A, Kruse I, Ryden L (1989) Atrial inhibited pacing in the sick sinus node syndrome:clinical value and the demand for rate responsiveness. PACE 12:954–961PubMedGoogle Scholar
  25. 25.
    Rosenquist M, Aren C, Kristensson BE, Nordlander R, Schüller H (1990) Atrial rate responsive pacing. Effect on exercise capacity. Eur Heart J 11:537–542Google Scholar
  26. 26.
    Rosenqvist M, Obel IW (1989) Atrial pacing and the risk for AV block:time for a change in attitude? PACE 12:97–101PubMedGoogle Scholar
  27. 27.
    Karlöf I (1975) Hemodynamic effect of atrial triggered versus fixed rate pacing at rest and during exercise in complete heart block. Acta Med Scand 197:195–206PubMedGoogle Scholar
  28. 28.
    Kruse I, Amman K, Conradsson TB, Rydeü L (1982) A comparison of acute and long term hemodynamic effects of ventricular inhibited and atrial synchronous ventricular inhibited pacing. Circulation 65:846–855PubMedCrossRefGoogle Scholar
  29. 29.
    Kristensson BE, Amman K, Ryden L (1985) The haemodynamic importance of atrioventricular synchrony and rate increase at rest and during exercise. Eur Heart J 6:773–778PubMedGoogle Scholar
  30. 30.
    Fananapazir L, Bennett HD, Monks P (1983) Atrial synchronized ventricular pacing:contribution of the chronotropic response to improved exercise performance. PACE 5:601–608Google Scholar
  31. 31.
    Heldman A, Nordlander R (1988) QT sensing rate adaptive pacing compared to fixed rate ventricular inhibited pacing. A controlled clinical study. PACE 12:374–385Google Scholar
  32. 32.
    Pehrsson SK (1983) Influence of heart rate and atrioventricular synchronization on maximal work load tolerance in patients treated with artificial pacemakers. Acta Med Scand 214:311–315PubMedCrossRefGoogle Scholar
  33. 33.
    Pehrsson SK, Nordlander R, Hedman A (1989) Rate responsive pacing and exercise capacity. PACE 12:749–751PubMedGoogle Scholar
  34. 34.
    Karlsson J, Nordlander R, Pehrsson SK, Äström H (1987) Myocardial oxygen demands of atrial triggered versus fixed rate ventricular pacing in patients with complete heart block. PACE 10:1154–1159PubMedGoogle Scholar
  35. 35.
    Pehrsson SK, Hjemdahl P, Nordlander R, Äström H (1988) Sympathoadrenal activity and cardiac performance at rest and during exercise in patients with ventricular demand compared to atrial synchronous pacing. Br Heart J 60:212–220PubMedCrossRefGoogle Scholar
  36. 36.
    Hedman A, Hjemdahl P, Nordlander R, Äström H (1990) Effects of mental and physical stress on central hemodynamics and cardiac sympathetic nerve activity during QT interval sensing rate responsive and fixed rate ventricular inhibited pacing. Eur Heart J 11:903–915PubMedGoogle Scholar
  37. 37.
    Linde-Edelstam C, Hjemdahl P, Pehrsson K, Äström H, Nordlander R (1990) Is DDD pacing superior to WI-R? Effects on myocardial sympathetic activity and myocardial oxygen consumption. PACE 15:425–434.Google Scholar
  38. 38.
    Bristow MR, Ginsburg R, Minobe W, Cubiciotti RS, Sageman WS, Lurie K, Billingham HE, Harrison DC, Stinson EB (1982) Decreased catecholamineamine sensitivity and betaadrenergireceptor density in failing human hearts. N Engl J Med 307:205–211PubMedCrossRefGoogle Scholar
  39. 39.
    Cohn JN, Levine B, Olivari MT, Gaiberg V, Lura D, Francis GS, Simon AB, Rector T (1984) plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–823PubMedCrossRefGoogle Scholar
  40. 40.
    Alpert MA, Curtis JJ, Sanfelippo JF, Flaker GC, Walls JT, Mukerji V, Villarreal SK, Madigan NP, Kroll RB (1986) Comparative survival after permanent ventricular and dual chamber pacing for patients with high degree atrioventricular block with and without preexistent congestive heart failure. J Am Coll Cardiol 7:925–932PubMedCrossRefGoogle Scholar
  41. 41.
    Linde-Edelstam C, Güllberg B, Nordlander R, Pehrson JK, Rosenquist M, Rydeü L (1992) Longevity in patients with high degree atrioventricular block paced in the atrioventricular synchronous or the fixed rate ventricular mode. PACE 15:304–313PubMedGoogle Scholar
  42. 42.
    Faerestrand S, Ohm OJ (1988) Dual chamber pacing (DDD) and activity sensing rateresponsive ventricular pacing (PRP):long-term effect on AV valvular function. PACE 11:851 (abstr)Google Scholar
  43. 43.
    Bubien RS, Kay GN (1990) A randomised comparison of quality of life and exercise capacity with DDD and VVIR pacing modes. PACE 13:524 (abstr.)Google Scholar
  44. 44.
    Sulke N, Dritsas A, Chambers J, Sowton E (1990) A randomized cross over study of four rate responsive modes. PACE 13:534 (abstr)Google Scholar
  45. 45.
    Higano ST (1990) Hemodynamic importance of atrioventricular synchrony during low levels of exercise. Cardiostim Rev Eur Technol Biomed 12:35:93Google Scholar
  46. 46.
    Alagona P (1990) Improved exercise tolerance with dual chamber versus single chamber rate adaptive pacing. Cardiostim Rev Eur Technol Biomed 12:57:181Google Scholar
  47. 47.
    Jutzy RV, Florio J, Isaeff DM, Marsa RJ, Bausal RC, Jutzy KR (1990) Comparative evaluation of rate modulated dual chamber pacing and VVIR pacing. Cardiostim Rev Eur Technol Biomed 12:57:182Google Scholar
  48. 48.
    Myreng Y, Nitter-Hause S (1989) Age-dependency of left ventricular filling dynamics and relaxation as assessed by pulsed Doppler-echocardiography. Clin Physiol 9:99–106PubMedCrossRefGoogle Scholar
  49. 49.
    Pearson AC, Labowitz AJ, Mrosek D, Williams GA, Kennedy HL (1987) Assessment of diastolic function in normal and hypertensive hearts:comparison of Doppler echocardiography and M-mode echocardiography. Am Heart J 113:1417–1425PubMedCrossRefGoogle Scholar
  50. 50.
    Murakami T, Hess OM, Gage JE, Grimm J, Krayenbiihl HP (1986) Diastolic filling dynamics in patients with aortic stenosis. Circulation 73:1162–1172PubMedCrossRefGoogle Scholar
  51. 51.
    Ilecito S, Amico A, Marangelli V, D’Ambrosio G, Rizzon P (1988) Doppler Echocardiography evaluation of the effect of atrial pacing-induced ischemia on left ventricular filling in patients with coronary artery disease. J Am Coll Cardiol 11:953–961CrossRefGoogle Scholar

Copyright information

© Springer Verlag, Berlin Heidelberg 1993

Authors and Affiliations

  • M. Rosenquist
  • C. Edelstam
  • R. Nordlander
    • 1
  1. 1.Department of CardiologyKarolinska HospitalStockholmSweden

Personalised recommendations