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Doppler Ultrasound Measurement of Cardiac Output in Patients with Physiologic Dual Chamber Pacemakers

  • Conference paper
Cardiac Pacing

Summary

Dual chamber pacemakers have recently come into widespread use. They offer practical advantages in restoring atrio-ventricular synchrony and in allowing rate variability in response to physiologic stresses. Doppler ultrasound allows non-invasive assessment of cardiac output in man. We used this technique to determine the changes in resting cardiac output itt patients with DDD pacemakers when the mode of pacing was varied from VVI to DDD at fixed heart rates.

Doppler ultrasound measurement of cardiac output was first validated with thermodilution measurements in 12 patients recovering from coronary bypass surgery (R = 0.83). Then twenty-seven patients with DDD pacemakers were assessed at rest with the heart rate fixed and the mode of pacing varied from VVI to DDD. There was a significant increase in cardiac output from 4.2 ± 0.4 (mean ± SEM) liters per minute in the VVI mode to 5.0 ± 0.4 in the DDD mode (p < 0.001). The degree of improvement in cardiac output was independent of ventricular function. The percentage increase in cardiac output averaged 16 ± 3% in those 12 patients with left ventricular ejection fraction greater than 40% and 27 ± 8% in those 15 patients with LVEF less than 40% (p = NS).

Substantially greater improvements in cardiac output occurred however, in those patients with evidence of the pacemaker syndrome or intact ventriculo-atrial conduction. In these 9 patients, there was a mean improvement of 39% ± 10% in cardiac output between VVI and DDD as opposed to an average increase of only 14% ± 3% in the 18 patients without VA conduction (p < 0.02). The patients with poor left ventricular function and VA conduction showed the most marked improvements. Thus, Doppler ultrasound can be used to quantitate the improvement in cardiac output which occurs in patients at rest with DDD pacing versus VVI pacing. This improvement is independent of the level of left ventricular function but is substantially higher when there is evidence of VA conduction or the pacemaker syndrome.

Albert S. Hyman Research Fellow in Cardiac Pacing, North American Society of Pacing and Electrophysiology

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Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, 02114, USA

    J. W. Harthorne M.D.

Authors
  1. V. C. Dicola
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  2. W. J. Stewart
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  3. J. W. Harthorne M.D.
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  4. A. E. Weyman
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K. Steinbach

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© 1983 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt

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Dicola, V.C., Stewart, W.J., Harthorne, J.W., Weyman, A.E. (1983). Doppler Ultrasound Measurement of Cardiac Output in Patients with Physiologic Dual Chamber Pacemakers. In: Steinbach, K. (eds) Cardiac Pacing. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-72367-4_35

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  • DOI: https://doi.org/10.1007/978-3-642-72367-4_35

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-72369-8

  • Online ISBN: 978-3-642-72367-4

  • eBook Packages: Springer Book Archive

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