title: The acute effect of cardiac pacing mode on endothelial vasodilation: prospective, double-blind, cross-over, comparative clinical study.
abstract: BACKGROUND
  Compared to atrioventricular sequential pacing, ventricular demand pacing is known to have somewhat more deleterious hemodynamic effects, which probably arise from increased sympathetic tonus and inappropriate baroreceptor activation. Endothelial function is affected by various local and systemic factors including baroreceptor activity. The aim of this study was to explore whether cardiac pacing would have any effect on endothelial functions.
  
  
  METHODS
  Twelve patients (six male, mean age: 75 +/- 9 years) with previously implanted DDD or VDDcardiac pacemakers were included. All patients had stable atrial rhythms during the study. Patients were randomized to either atrial-based pacing mode (VDD or DDD) or ventricular demand pacing mode (VVI) first, and then cross-over was performed with the other pacing mode. Endothelial function was assessed by brachial artery ultrasonography. Basal diameter of the brachial artery, and both flow-mediated dilation (FMD) and endothelium-independent vasodilation with nitroglycerin were measured 1 hour after each pacing mode.
  
  
  RESULTS
  Compared to atrial-based pacing mode, ventricular demand pacing was associated with a significantly worse FMD both as absolute and percentage values (0.17 +/- 0.09 mm vs 0.28 +/- 0.11 mm, P = 0.015 and 4.84 +/- 2.37 % vs 7.00 +/- 2.88 %, P = 0.028, respectively). However, there was no significant difference in nitroglycerin-mediated vasodilation values between the two pacing sessions.
  
  
  CONCLUSIONS
  Acute ventricular demand pacing (VVI pacing) is clearly associated with attenuation of FMD in patients with atrial-based pacing systems. The attenuation of endothelial vasodilation might have a role in hemodynamic and clinical deterioration in patients with VVI pacemakers.
authors.affiliation: Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey. besteozben@yahoo.com
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Fak
authors.forename: Beste
authors.initials: B
authors.lastname: Ozben
authors.forename: Ahmet
authors.initials: A
authors.lastname: Toprak
authors.forename: A Altug
authors.initials: AA
authors.lastname: Cincin
authors.forename: Nurdan
authors.initials: N
authors.lastname: Papila
authors.forename: M Azra
authors.initials: MA
authors.lastname: Tanrikulu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Oktay
mesh_terms: D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000628:therapy*; D001794:Blood Pressure; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014664:Vasodilation