Immediate impairment of left ventricular mechanical performance and force-frequency relation by rate-responsive dual-chamber, but not atrial pacing

Implications from intraventricular isovolumic relaxation flow

Mao Shin Lin, Jiunn Lee Lin, Yen Bin Liu, Chau Chung Wu, Lung Chun Lin, Ming Fong Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Despite the maintenance of atrioventricular (AV) synchrony, the detrimental effect of left ventricular asynchronization on mechanical performance and intraventricular flow by nonphysiologic right ventricular apical pacing in dual-chamber pacing, with and without rate adaptation, is not clear. Method: Twenty-seven consecutive patients receiving permanent pacemakers for symptomatic bradyarrhythmias (18 with DDD and 9 with AAI mode pacemakers) were evaluated with standard and tissue Doppler echocardiography before and 24 h after pacemaker implantation. The rate-response effect of pacing was studied by programmed rate with increments of 20, from 60 to 100/min. Results: Color M-mode echocardiography demonstrated that much more DDD patients developed new biphasic intraventricular flow during isovolumic relaxation period than AAI patients (13 / 18 versus 0 / 9, P < 0.001). In DDD patients, the ventricular relaxation represented by mitral annulus velocity in early diastole significantly attenuated (before vs. after DDDR, 8.5 ± 2.8 vs. 5.2 ± 1.2 cm/s, P < 0.05), and also the mitral flow propagation velocity (33 ± 11 vs. 25 ± 5 cm/s, P < 0.01). The myocardial performance index increased after DDD (0.70 ± 0.15 vs. 0.79 ± 0.24, P < 0.05) but not after AAI (0.61 ± 0.1 vs. 0.59 ± 0.08, P = NS). For both pacing groups, the accelerated pacing rate prolonged the isovolumic relaxation time and shortened the diastole period (P < 0.001). However, only DDD patients had a decreased mitral flow propagation velocity (P = 0.026) and an attenuated force-frequency relation in programmed rate acceleration. Conclusion: Despite the AV synchrony, right ventricular apical pacing immediately attenuates the left ventricular contraction and relaxation performance, which deteriorated further and suppressed the physiologically positive force-frequency relation after accelerated pacing rate.

Original languageEnglish
Pages (from-to)367-374
Number of pages8
JournalInternational Journal of Cardiology
Volume109
Issue number3
DOIs
Publication statusPublished - May 24 2006
Externally publishedYes

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Dichlorodiphenyldichloroethane
Diastole
Doppler Echocardiography
Bradycardia
Echocardiography
Color
Maintenance

Keywords

  • Diastolic dysfunction
  • Echocardiography
  • Pacemaker
  • Tissue Doppler imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Immediate impairment of left ventricular mechanical performance and force-frequency relation by rate-responsive dual-chamber, but not atrial pacing : Implications from intraventricular isovolumic relaxation flow. / Lin, Mao Shin; Lin, Jiunn Lee; Liu, Yen Bin; Wu, Chau Chung; Lin, Lung Chun; Chen, Ming Fong.

In: International Journal of Cardiology, Vol. 109, No. 3, 24.05.2006, p. 367-374.

Research output: Contribution to journalArticle

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abstract = "Background: Despite the maintenance of atrioventricular (AV) synchrony, the detrimental effect of left ventricular asynchronization on mechanical performance and intraventricular flow by nonphysiologic right ventricular apical pacing in dual-chamber pacing, with and without rate adaptation, is not clear. Method: Twenty-seven consecutive patients receiving permanent pacemakers for symptomatic bradyarrhythmias (18 with DDD and 9 with AAI mode pacemakers) were evaluated with standard and tissue Doppler echocardiography before and 24 h after pacemaker implantation. The rate-response effect of pacing was studied by programmed rate with increments of 20, from 60 to 100/min. Results: Color M-mode echocardiography demonstrated that much more DDD patients developed new biphasic intraventricular flow during isovolumic relaxation period than AAI patients (13 / 18 versus 0 / 9, P < 0.001). In DDD patients, the ventricular relaxation represented by mitral annulus velocity in early diastole significantly attenuated (before vs. after DDDR, 8.5 ± 2.8 vs. 5.2 ± 1.2 cm/s, P < 0.05), and also the mitral flow propagation velocity (33 ± 11 vs. 25 ± 5 cm/s, P < 0.01). The myocardial performance index increased after DDD (0.70 ± 0.15 vs. 0.79 ± 0.24, P < 0.05) but not after AAI (0.61 ± 0.1 vs. 0.59 ± 0.08, P = NS). For both pacing groups, the accelerated pacing rate prolonged the isovolumic relaxation time and shortened the diastole period (P < 0.001). However, only DDD patients had a decreased mitral flow propagation velocity (P = 0.026) and an attenuated force-frequency relation in programmed rate acceleration. Conclusion: Despite the AV synchrony, right ventricular apical pacing immediately attenuates the left ventricular contraction and relaxation performance, which deteriorated further and suppressed the physiologically positive force-frequency relation after accelerated pacing rate.",
keywords = "Diastolic dysfunction, Echocardiography, Pacemaker, Tissue Doppler imaging",
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T2 - Implications from intraventricular isovolumic relaxation flow

AU - Lin, Mao Shin

AU - Lin, Jiunn Lee

AU - Liu, Yen Bin

AU - Wu, Chau Chung

AU - Lin, Lung Chun

AU - Chen, Ming Fong

PY - 2006/5/24

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N2 - Background: Despite the maintenance of atrioventricular (AV) synchrony, the detrimental effect of left ventricular asynchronization on mechanical performance and intraventricular flow by nonphysiologic right ventricular apical pacing in dual-chamber pacing, with and without rate adaptation, is not clear. Method: Twenty-seven consecutive patients receiving permanent pacemakers for symptomatic bradyarrhythmias (18 with DDD and 9 with AAI mode pacemakers) were evaluated with standard and tissue Doppler echocardiography before and 24 h after pacemaker implantation. The rate-response effect of pacing was studied by programmed rate with increments of 20, from 60 to 100/min. Results: Color M-mode echocardiography demonstrated that much more DDD patients developed new biphasic intraventricular flow during isovolumic relaxation period than AAI patients (13 / 18 versus 0 / 9, P < 0.001). In DDD patients, the ventricular relaxation represented by mitral annulus velocity in early diastole significantly attenuated (before vs. after DDDR, 8.5 ± 2.8 vs. 5.2 ± 1.2 cm/s, P < 0.05), and also the mitral flow propagation velocity (33 ± 11 vs. 25 ± 5 cm/s, P < 0.01). The myocardial performance index increased after DDD (0.70 ± 0.15 vs. 0.79 ± 0.24, P < 0.05) but not after AAI (0.61 ± 0.1 vs. 0.59 ± 0.08, P = NS). For both pacing groups, the accelerated pacing rate prolonged the isovolumic relaxation time and shortened the diastole period (P < 0.001). However, only DDD patients had a decreased mitral flow propagation velocity (P = 0.026) and an attenuated force-frequency relation in programmed rate acceleration. Conclusion: Despite the AV synchrony, right ventricular apical pacing immediately attenuates the left ventricular contraction and relaxation performance, which deteriorated further and suppressed the physiologically positive force-frequency relation after accelerated pacing rate.

AB - Background: Despite the maintenance of atrioventricular (AV) synchrony, the detrimental effect of left ventricular asynchronization on mechanical performance and intraventricular flow by nonphysiologic right ventricular apical pacing in dual-chamber pacing, with and without rate adaptation, is not clear. Method: Twenty-seven consecutive patients receiving permanent pacemakers for symptomatic bradyarrhythmias (18 with DDD and 9 with AAI mode pacemakers) were evaluated with standard and tissue Doppler echocardiography before and 24 h after pacemaker implantation. The rate-response effect of pacing was studied by programmed rate with increments of 20, from 60 to 100/min. Results: Color M-mode echocardiography demonstrated that much more DDD patients developed new biphasic intraventricular flow during isovolumic relaxation period than AAI patients (13 / 18 versus 0 / 9, P < 0.001). In DDD patients, the ventricular relaxation represented by mitral annulus velocity in early diastole significantly attenuated (before vs. after DDDR, 8.5 ± 2.8 vs. 5.2 ± 1.2 cm/s, P < 0.05), and also the mitral flow propagation velocity (33 ± 11 vs. 25 ± 5 cm/s, P < 0.01). The myocardial performance index increased after DDD (0.70 ± 0.15 vs. 0.79 ± 0.24, P < 0.05) but not after AAI (0.61 ± 0.1 vs. 0.59 ± 0.08, P = NS). For both pacing groups, the accelerated pacing rate prolonged the isovolumic relaxation time and shortened the diastole period (P < 0.001). However, only DDD patients had a decreased mitral flow propagation velocity (P = 0.026) and an attenuated force-frequency relation in programmed rate acceleration. Conclusion: Despite the AV synchrony, right ventricular apical pacing immediately attenuates the left ventricular contraction and relaxation performance, which deteriorated further and suppressed the physiologically positive force-frequency relation after accelerated pacing rate.

KW - Diastolic dysfunction

KW - Echocardiography

KW - Pacemaker

KW - Tissue Doppler imaging

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