Atrial systole contribution to cardiac output: more than just volume

Muñoz, Durán; Mur, José Luis Moya; Becker, Daniel E.; Santos, Sara Fernández; Rivera, Carla Lázaro; Rojo, Eduardo Casas; Tejedor, Paula; Delgado-Montero, Antonia; Fernández-Golfín, Covadonga; Gomez, J L Zamorano

doi:10.1093/eurheartj/eht308.p1122

Cited by 2 publications

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“…Better functional capacity was also observed in our study in patients with dual-chamber pacemakers in comparison to single-chamber (ventricular) pacemakers, an expected result taking into account the fact that dual-chamber pacemakers preserve the atrioventricular synchronicity which increases cardiac output by up to 25% (17,18). Chabernaud et al compared single-chamber and dual-chamber pacing modes in 10 patients, observing a superior exercise capacity with dual-chamber pacing mode (19).…”

Section: Discussionsupporting

confidence: 76%

The Influence of Cardiac Pacemaker Programming Modes on Exercise Capacity

Caloian

Sitar-Tăut

Gușetu

et al. 2018

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Abstract. Background A pacemaker not only has the role of preventing the heart rate from dropping under a certain limit, but can also have an important influence on the exercise capacity (1), as the pacing mode influences atrioventricular synchronicity (single-chamber vs. dual-chamber pacemakers) (2, 3) and the response of the heart rate to physical exercise (rate responsive function, mode switch function) (4, 5).Most patients who have a pacemaker implanted for sick sinus syndrome or for atrioventricular blocks need to be enrolled in cardiac rehabilitation programs in order to improve their exercise capacity and quality of life. One of the most important components of cardiac rehabilitation is physical exercise, a programme that needs to be individualized for each patient by taking into account various factors such as age, gender, risk factors, comorbidities, and fitness level (6).The first step in prescribing a physical training plan is the evaluation of the maximum exercise capacity of the patient through a standardized exercise stress test, noting the symptoms that forced the patient to stop the test, the maximum workload, the variations of the patient's blood pressure, heart rate, oxygen saturation, significant arrhythmias or ischemic changes recorded on the electrocardiographic (ECG) monitoring (7-9).Besides the parameters mentioned above, the pacemakerwearing patient needs a more complex assessment during exercise because some particular events might occur: the heart rate might not adapt to exercise in patients with chronotropic incompetence, resulting in early left ventricular failure; atrioventricular conduction disturbances could worsen, causing symptoms such as dyspnoea, dizziness or even syncope; tachyarrhythmia or ischemic changes can be difficult to diagnose on an ECG recording during paced atrial or ventricular beats (10, 11).In the present study, we focused on the exercise capacity of patients with cardiac pacemakers and on the benefits or the disadvantages brought by choosing a particular programming mode. Most of the studies that evaluated the exercise capacity of pacemaker-wearing patients enrolled a limited number of individuals and returned discordant results.The purpose of our study was to compare the influence of the most common pacemaker programming modes on the exercise capacity of the patients. 419

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Section: Discussionsupporting

confidence: 76%

The Influence of Cardiac Pacemaker Programming Modes on Exercise Capacity

Caloian

Sitar-Tăut

Gușetu

et al. 2018

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“…The lack of atrial contractions, as in the case of patients suffering from atrial fibrillation, can determine a decrease in cardiac output of up to 25% [13]. A similar clinical situation is met in patients in sinus rhythm which receive a VVI pacemaker.…”

Section: Discussionmentioning

confidence: 94%

The effect of cardiac pacemaker implantation on cardiac performance – the experience of a Cardiology – Rehabilitation Department

Caloian¹,

Gușetu²,

Costea³

et al. 2018

Balneo

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Background. Although cardiac pacemakers can prevent the occurrence of heart failure secondary to low cardiac output in patients suffering from extreme bradycardia, they can also induce, in some circumstances, heart failure by decreasing the left ventricular stroke volume. In our study, we aim to describe the effect of permanent cardiac pacing on the evolution of patients with heart failure, objectively determined by the N-terminal pro b-type natriuretic peptide (NT-proBNP) dynamics. Material and methods. Complete clinical examination and determination of NT-proBNP were performed before and 5 days after pacemaker implantation. Results. We enrolled in our study 32 patients with an indication for permanent cardiac pacing in which we implanted 21 single-chamber ventricular pacemakers (VVI, 65.6%), 4 single-chamber atrial pacemakers (AAI, 12.5%) and 7 dual-chamber atrio-ventricular pacemakers (DDD, 21.9%). Patients with heart failure had an average NT-proBNP value of 2542.2±2311.12 pg/mL and patients without heart failure (control group), had an average NT-proBNP value of 190.58±98.16pg/mL. Patients in sinus rhythm that received a VVI pacemaker experienced an increase in NT-proBNP values of 103.73%, while patients in atrial fibrillation and VVI of only 0.27%. NT-proBNP values decreased in patients in sinus rhythm that received a DDD or AAI pacemaker by 20.94%. Conclusion. Permanent cardiac pacemakers are able to influence the clinical status of patients with heart failure, especially if they cause the loss of atrio-ventricular synchronism.

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Atrial systole contribution to cardiac output: more than just volume

Cited by 2 publications

References 0 publications

The Influence of Cardiac Pacemaker Programming Modes on Exercise Capacity

The Influence of Cardiac Pacemaker Programming Modes on Exercise Capacity

The effect of cardiac pacemaker implantation on cardiac performance – the experience of a Cardiology – Rehabilitation Department

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