TY - JOUR
T1 - Effects of right ventricular pacing sites on blood pressure variation in upright posture
T2 - A comparison of septal vs. apical pacing sites
AU - Kohno, Ritsuko
AU - Abe, Haruhiko
AU - Nakajima, Hiroshi
AU - Hayashi, Katsuhide
AU - Oginosawa, Yasushi
AU - Benditt, David G.
N1 - Publisher Copyright:
© 2016 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Aims: Large variations in blood pressure (BP) in the upright position are a major cause of pacemaker syndrome, observed in up to 80% of patients paced non-physiologically at the right ventricular (RV) apex. We hypothesized that the magnitude of BP variations might be influenced by the RV pacing site. To assess this, we compared haemodynamic findings during supine and upright posture with RV apical vs. septal pacing. Methods and results: The study population comprised a retrospective cohort of 24 dual-chamber pacemaker patients with advanced or complete atrioventricular block, in which 11 were randomly chosen from those with RV apical pacing, and 13 randomly chosen from those with septal pacing. Studies were performed during fixed rate VVI and DDD pacing modes with patients in both supine and passive head-up tilt positions. Continuous BP, stroke volume, cardiac index, and total peripheral resistance index were measured non-invasively. During RV apical pacing, there were significant differences of beat-to-beat BP variation after movement from supine to upright posture for both VVI and DDD pacing modes (P < 0.05); however, this was not the case for either mode during RV septal pacing. Further, comparing RV apical to RV septal pacing in the supine position, there were no BP variation differences for either DDD or VVI modes. Conversely, in the upright position BP variation was significantly greater during RV apical vs. RV septal VVI pacing (P = 0.017) but not during DDD pacing. Conclusion: During VVI pacing, RV septal pacing exhibited lesser BP variation during upright posture compared with RV apical pacing.
AB - Aims: Large variations in blood pressure (BP) in the upright position are a major cause of pacemaker syndrome, observed in up to 80% of patients paced non-physiologically at the right ventricular (RV) apex. We hypothesized that the magnitude of BP variations might be influenced by the RV pacing site. To assess this, we compared haemodynamic findings during supine and upright posture with RV apical vs. septal pacing. Methods and results: The study population comprised a retrospective cohort of 24 dual-chamber pacemaker patients with advanced or complete atrioventricular block, in which 11 were randomly chosen from those with RV apical pacing, and 13 randomly chosen from those with septal pacing. Studies were performed during fixed rate VVI and DDD pacing modes with patients in both supine and passive head-up tilt positions. Continuous BP, stroke volume, cardiac index, and total peripheral resistance index were measured non-invasively. During RV apical pacing, there were significant differences of beat-to-beat BP variation after movement from supine to upright posture for both VVI and DDD pacing modes (P < 0.05); however, this was not the case for either mode during RV septal pacing. Further, comparing RV apical to RV septal pacing in the supine position, there were no BP variation differences for either DDD or VVI modes. Conversely, in the upright position BP variation was significantly greater during RV apical vs. RV septal VVI pacing (P = 0.017) but not during DDD pacing. Conclusion: During VVI pacing, RV septal pacing exhibited lesser BP variation during upright posture compared with RV apical pacing.
KW - Blood pressure control
KW - Pacemaker syndrome
KW - Septal pacing
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U2 - 10.1093/europace/euv298
DO - 10.1093/europace/euv298
M3 - Article
C2 - 26851814
AN - SCOPUS:85027470393
SN - 1099-5129
VL - 18
SP - 1023
EP - 1029
JO - Europace
JF - Europace
IS - 7
ER -