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Am J Physiol Heart Circ Physiol (May 26, 2006). doi:10.1152/ajpheart.00254.2006
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Submitted on March 12, 2006
Accepted on May 22, 2006

Adverse Effects of Atrioventricular Synchronous Right Ventricular Pacing on Left Ventricular Sympathetic Activity, Efficiency and Hemodynamic Status

Abdul Al-Hesayen1 and John D. Parker2*

1 Medicine/Cardiology, St. Michael's Hospital, Toronto, Canada
2 Head, Division of Cardiology, Mount Sinai and University Network Hospitals, Professor of Medicine and Pharmacology, University of Toronto, Toronto, Ontario, Canada

* To whom correspondence should be addressed. E-mail: jdp{at}ca.inter.net.

Right ventricular (RV) pacing is now recognized to play a role in the development of heart failure in patients with and without underlying left ventricular (LV) dysfunction. We used the cardiac norepinephrine spillover method to test the hypothesis that right ventricular pacing is associated with cardiac sympathetic activitation. We studied 8 patients with normal LV function using temporary right atrial and ventricular pacing wires. All measurements were carried out during a fixed atrial pacing rate. The radiotracer norepinephrine spillover technique was employed to measure total body and cardiac sympathetic activity while changes in LV performance were evaluated with a high fidelity manometer catheter. Atrioventricular synchronous RV pacing, as compared to atrial pacing alone, was associated with a 65% increase in cardiac norepinephrine spillover, an increase in LV end-distolic pressure and a reduction in myocardial efficiency. These responses may play a role in the development of heart failure and poor outcomes that are associated with chronic RV pacing.




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