Evaluation of the early hemodynamic changes in carotid arteries during ventricular and dual chamber pacing.
In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end-diastolic velocity (EDV), cross-sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 +/- 24.9 cm/s) and right CCA (84.1 +/- 18.7) were shown to significantly decrease after VVI pacing (60.1 +/- 16.6 and 62.1 +/- 20.0, respectively). There was also a similar significant decrease in PSV in the left and right ICAs and ECAs. Besides PSV, RI, and PI in the left and right CCAs, ICAs, and ECAs significantly decreased after VVI pacing. There was no similar decrease after DDD pacing. Cross-sectional area and flow volume in the CCA, ICA, and ECA were similar after DDD and VVI pacing and before pacemaker implantation suggesting that cardiac output was similar when the measurements were recorded. Carotid artery PSVs, pulsatility, and RIs were found to be significantly decreased during VVI pacing compared to baseline and DDD pacing. The greater incidence of adverse cerebral outcomes in patients with VVI rather than DDD pacing may be partly due to decreased carotid PSVs.
Soylu
Mustafa
M
Cardiology Clinics, Türkiye Yüksek_htisas Hospital, Ankara, Turkey. soyumo@superonline.com
Ozdemir
Ozcan
O
Geyik
Bilal
B
Ozbakir
Cemal
C
Demir
Ahmet Duran
AD
Duru
Erdal
E
Ozbal
Serra
S
Hekimoglu
Baki
B
Ozer
Tulay
T
Arda
Kemal
K
D001146:Arrhythmia, Sinus / Q000628:therapy; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D001919:Bradycardia / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006327:Heart Block / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011673:Pulsatile Flow / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012804:Sick Sinus Syndrome / Q000628:therapy; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance / Q000502:physiology