title: [Delayed atrial excitation following bifocal pacemaker stimulation].
abstract: A patient with drug-resistant ventricular tachycardia due to ischemic heart disease with severe left ventricular failure was successfully treated by the implantation of a DDD pacemaker system pacing at a rate of 90 beats/min (overdrive suppression). Additional therapy with high doses of beta-blockers was necessary. The ECG demonstrated a delay of 100 ms between atrial spike and p-wave. The hemodynamic effects of this ineffective atrial contraction were assessed by jugular venous puls tracing, phonocardiography, echocardiography, and radionuclide-ventriculography. The desired positive effects of physiological pacing could only be achieved by further prolongation of the A-V interval by these 100 ms. This observation shows that, with DDD pacemakers, AV intervals of varying length may be necessary with VAT or VDD and DVI modes in individual cases.
mesh_terms: D004452:Echocardiography; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D010138:Pacemaker, Artificial; D013610:Tachycardia / Q000503:physiopathology / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy
vernacular_title: Verzögerte Vorhoferregung nach bifokaler Schrittmacherstimulation.