Does atrial synchronous (VAT) pacing improve hemodynamics and myocardial oxygen consumption compared to ventricular inhibited (VVI) pacing in patients with complete heart block?
Atrial synchronous pacing provides higher cardiac output during exercise than fixed-rate ventricular pacing without increasing myocardial oxygen demand in patients with complete heart block.
Hemodynamics, myocardial oxygen consumption, and lactate concentration were determined by cardiac catheterization at rest and during exercise in eight patients treated with AV universal pacemakers (DDD) for high degree AV block. The pulse generator was alternately programmed in ventricular inhibited (VVI) or atrial synchronous (VAT) mode. During VVI pacing, the cardiac output rose between rest and exercise (4.3-7.6 L/min) due to increased stroke volume. VAT pacing gave significantly greater increase (4.5-8.8 L/min) which, as the stroke volume was unchanged, resulted from accelerated heart rate. The myocardial oxygen consumption and the coronary blood flow did not differ between VVI and VAT mode at rest or during exercise, nor did the modes make a difference in arterial systolic and pulmonary wedge pressures. These observations suggested that VAT pacing offers higher cardiac output than VVI pacing, but with similar demands on myocardial oxygen consumption.
Nordlander et al. (Tue,) studied this question.