Hemodynamic consequences of atrial and ventricular pacing in patients with normal and abnormal hearts

Benchimol, Alberto; Ellis, Joseph G.; Dimond, E. Grey

doi:10.1016/0002-9343(65)90113-0

Cited by 151 publications

(19 citation statements)

References 30 publications

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“…Except for one patient, R.J., a good individual correlation was noted between stroke volume and pulse pressure (Table IV, (12,13). Thus, stroke volume, which by the Frank Starling principle is dependent upon end-diastolic volume, will vary with preceding cycle length, and for any given cycle length will be less than in sinus rhythm.…”

Section: Column 5)mentioning

confidence: 89%

Pressure-flow studies in man during atrial fibrillation

Greenfield¹,

Harley²,

Thompson³

et al. 1968

J. Clin. Invest.

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A B S T R A C T In 13 patients who had atrial fibrillation the ascending aortic pressure-flow relationships were measured by the pressure gradient technique. Both the pressure and flow curves were similar in contour to ones previously obtained by this method. From these recordings, relationships between the phases of systole, the ventricular filling time, and various derived parameters of pressure and flow such as the pulse pressure, stroke volume, peak flow, stroke work, and peak power were evaluated. For stroke volumes greater than 15 cm3 there was little change in the duration of systole in an individual patient. In each patient both the preejection period and the duration of ejection showed a good correlation with stroke volume, peak flow, stroke work, and peak power. When data from all patients were examined, the relationship between stroke volume and duration of ejection was found to be curvilinear and had an overall correlation of r = 0.91. There was marked variation from patient to patient in duration of both the preejection period and systole. Similar correlations between the phases of systole were noted with peak flow, peak power, and stroke work. A positive but mediocre correlation was found between the previous RR interval (an index of ventricular filling time) and the subsequent stroke volume. The correlation, in six patients, between two previous RR intervals and stroke volume was considerably better. The relationship between the pulse pressure and stroke volume was reasonably close except in one patient; however, the group correlation was poor due to differences between individuals.

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Section: Column 5)mentioning

confidence: 89%

Pressure-flow studies in man during atrial fibrillation

Greenfield¹,

Harley²,

Thompson³

et al. 1968

J. Clin. Invest.

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“…This has subsequently been observed by others.3-' Still others have shown that as a consequence of electrical activation from a ventricular site, the temporal relationship between atrial and ventricular contraction is changed, resulting in the loss of atrial contribution to ventricular filling that in turn affects cardiac output.-7 The hemodynamic significance of atrial systole has been carefully analyzed under experimental as well as clinical conditions. 16 Its contribution to overall left ventricular performance at rest and during exercise is considered negligible under normal physiologic circumstances, while in situations of left ventricular hypertrophy or failure, cardiac output is enhanced by a normally timed atrial contraction. In addition, this uncoupling of atrial and ventricular contraction may result in a slight degree of mitral valve regurgitation since atrial contraction plays an active role in mitral valve closure.…”

Section: Discussionmentioning

confidence: 99%

Effects of altered site of electrical activation on myocardial performance during inotropic stimulation.

Heyndrickx¹,

Vilaine²,

Knight³

et al. 1985

Circulation

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“…The concept that the ventricle plays a part in its own filling by exerting a pulling force during ventricular relaxation has long been debated, but dismissed, by Harvey (1628) and most contemporary physiologists (see Channer & Jones, 1988, for historical review). In man the role of atrial systole in ventricular filling has previously been measured invasively from changes seen on cineangiograms (Matsuda, Toma, Ogawa, Matsuzaki, Katayama, Fujii, Yoshino, Moritani, Kumada & Kusukawa, 1983) and by using pacing techniques to separate the effect of ventricular contraction alone from that of atrioventricular synchronous contraction (Benchimol et al 1965). With the advent of Doppler echocardiography an estimation of the contribution to ventricular filling of atrial systole can be made non-invasively and under changing physiological conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Early physiologists (Gesell, 1916;Wiggers & Katz, 1921;Jochim, 1938) showed that properly timed atrial systole accounted for up to 50% of cardiac output in the isolated mammalian heart preparation. In normal man, using overdrive ventricular and atrial pacing, Benchimol, Ellis & Dimond (1965) showed that its contribution was low (perhaps about 10 % of cardiac output). More recently Doppler ultrasound combined with real-time cardiac imaging (duplex scanning) has allowed transmitral flow to be studied non-invasively (Channer, Culling, Wilde & Jones, 1986; Kuo, Quinones, Rokey, Sartori, Abinader & Zoghbi, 1987).…”

Section: Introductionmentioning

confidence: 99%

The contribution of atrial systole to mitral diastolic blood flow increases during exercise in humans.

Channer

Jones

1989

The Journal of Physiology

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SUMMARY1. The change in the relative contribution of the early passive and later active phases of transmitral flow to left ventricular filling was studied using Doppler echocardiography in ten normal male subjects during mild exercise.2. The peak velocity of passive flow increased during exercise by a mean of 16 % whereas peak velocity of active flow increased by a mean of 89 %. Hence the ratio of the peak velocities decreased in a linear fashion with a correlation coefficient of r =-095.3. The ratio of the Doppler-derived velocity-time integrals (equivalent to the ratio of flow) of the two phases of transmitral flow also showed a significant negative linear correlation of r = -0-97.4. Active atrial transport (atrial systole) progressively increases its contribution to overall transmitral blood flow with increasing heart rate during mild exercise. This effect is mainly mediated by an increase in flow velocity which is related to increased atrial contractility.

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Hemodynamic consequences of atrial and ventricular pacing in patients with normal and abnormal hearts

Cited by 151 publications

References 30 publications

Pressure-flow studies in man during atrial fibrillation

Pressure-flow studies in man during atrial fibrillation

Effects of altered site of electrical activation on myocardial performance during inotropic stimulation.

The contribution of atrial systole to mitral diastolic blood flow increases during exercise in humans.

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