Usefulness of rate regulation through continuous ventricular pacing in patients with drug-controlled slower atrial fibrillation and normal or depressed left ventricular systolic function.
We studied 33 clinically stable patients with permanent atrial fibrillation (AF), implanted with a ventricular demand rate-responsive (VVIR) pacemaker or an automatic defibrillator, in order to evaluate whether continuous right ventricular apex pacing (VP) conferring rate regulation may be advantageous when compared with slower drug-controlled AF. Devices were chronically programmed at ventricular backup pacing. Patients were divided in two groups according to their normal (n = 17) or depressed (n = 16) left ventricular systolic function (LVSF). Ventricular function was studied by using tissue Doppler and color M-mode and echocardiography, as well as B-type natriuretic peptide (BNP) measurements. Baseline data during AF were compared to corresponding measurements following a 1-month pacing period after the devices were programmed at a base rate of 70 beats/min. In both groups, VP worsened some indexes of left and right ventricular function (P < 0.05) without significantly affecting cardiac output, left ventricular filling pressures and BNP (P = not significant). We conclude that VP should not be considered advantageous compared to slower AF.
Chiladakis
John
J
Cardiology Department, University Hospital of Patras, 26500 Rion, Patras, Greece. chil@otenet.gr
Koutsogiannis
Nikolaos
N
Kalogeropoulos
Andreas
A
Zagli
Fani
F
Arvanitis
Panagiotis
P
Alexopoulos
Dimitrios
D
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology*
D000889:Anti-Arrhythmia Agents; D020097:Natriuretic Peptide, Brain