Does adjusting artificial pacing rate to 45/min improve symptoms and hemodynamics in a patient with mitral insufficiency and pacemaker-induced asynchrony?
In a patient with mitral insufficiency, pacemaker-induced beats can cause severe hemodynamic compromise due to atrioventricular asynchrony, which can be managed by lowering the pacing rate to avoid competition.
ABSTRACT A 70‐year‐old, artificially paced woman with dizziness and extremely low physical capacity exhibited a systolic BP varying from one moment to another; in standing position it was not measurable. With the aid of a strain gauge technique, the amplitude of the pulse wave of her left thumb was recorded and shown to vary widely. The variations were correlated to synchrony or asynchrony between atrial and ventricular activity. Pronounced decreases in stroke volume and peripheral pulse volume were recorded with pacemaker‐induced beats compared with idioventricular beats. With artificial stimulation at a rate of 45/min, thus avoiding competition but still protecting her from syncopes, she was free from symptoms.
Edhag et al. (Wed,) studied this question.