Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers. Effects of left ventricular function and retrograde ventriculoatrial conduction

William J. Stewart, Vincent C. Dicola, J. Warren Harthorne, Linda Gillam, Arthur E. Weyman

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Dual-chamber cardiac pacing (DDD) offers obvious theoretical advantages over traditional ventricular demand (VVI) pacing. Nevertheless, no widely agreed upon criteria exist for the selection of patients for physiologic DDD pacemakers compared with the simpler VVI systems. Accordingly, a non-invasive method for measuring cardiac output (Doppler ultrasound) was used to identify candidates for pacing who would derive the greatest hemodynamic benefit from DDD vs VVI pacing. Among 29 patients studied at rest during VVI-mode pacing, the average cardiac output by Doppler ultrasound was 4.3 ±0.3 liters/min (mean ± standard error of the mean). In the DDD mode, the average cardiac output was 5.0 +- 0.3 liters/min (p <0.001). Baseline left ventricular ejection fraction did not identify a group that improved more with DDD pacing. Patients who showed either retrograde ventriculoatrial conduction or described symptoms consistent with the "pacemaker syndrome" during VVI pacing, however, showed greater increases in cardiac output during DDD pacing. In these patients, the mean improvement in cardiac output was 30.4 ± 8.6% with DDD vs VVI pacing, as opposed to an average increase of only 14.4 ± 3.4% in the remaining 20 patients (p = 0.02). Thus, Doppler ultrasound can be used to quantitate the change in cardiac output at rest that occurs with DDD vs VVI pacing. The change is independent of the level of left ventricular function but is substantially higher when there is evidence of ventriculoatrial conduction or the pacemaker syndrome.

Original languageEnglish (US)
Pages (from-to)308-312
Number of pages5
JournalThe American Journal of Cardiology
Volume54
Issue number3
DOIs
StatePublished - Aug 1 1984
Externally publishedYes

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Dichlorodiphenyldichloroethane
Doppler Ultrasonography
Left Ventricular Function
Cardiac Output
Patient Selection
Stroke Volume
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers. Effects of left ventricular function and retrograde ventriculoatrial conduction",
abstract = "Dual-chamber cardiac pacing (DDD) offers obvious theoretical advantages over traditional ventricular demand (VVI) pacing. Nevertheless, no widely agreed upon criteria exist for the selection of patients for physiologic DDD pacemakers compared with the simpler VVI systems. Accordingly, a non-invasive method for measuring cardiac output (Doppler ultrasound) was used to identify candidates for pacing who would derive the greatest hemodynamic benefit from DDD vs VVI pacing. Among 29 patients studied at rest during VVI-mode pacing, the average cardiac output by Doppler ultrasound was 4.3 ±0.3 liters/min (mean ± standard error of the mean). In the DDD mode, the average cardiac output was 5.0 +- 0.3 liters/min (p <0.001). Baseline left ventricular ejection fraction did not identify a group that improved more with DDD pacing. Patients who showed either retrograde ventriculoatrial conduction or described symptoms consistent with the {"}pacemaker syndrome{"} during VVI pacing, however, showed greater increases in cardiac output during DDD pacing. In these patients, the mean improvement in cardiac output was 30.4 ± 8.6{\%} with DDD vs VVI pacing, as opposed to an average increase of only 14.4 ± 3.4{\%} in the remaining 20 patients (p = 0.02). Thus, Doppler ultrasound can be used to quantitate the change in cardiac output at rest that occurs with DDD vs VVI pacing. The change is independent of the level of left ventricular function but is substantially higher when there is evidence of ventriculoatrial conduction or the pacemaker syndrome.",
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Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers. Effects of left ventricular function and retrograde ventriculoatrial conduction. / Stewart, William J.; Dicola, Vincent C.; Harthorne, J. Warren; Gillam, Linda; Weyman, Arthur E.

In: The American Journal of Cardiology, Vol. 54, No. 3, 01.08.1984, p. 308-312.

Research output: Contribution to journalArticle

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T1 - Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers. Effects of left ventricular function and retrograde ventriculoatrial conduction

AU - Stewart, William J.

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AU - Weyman, Arthur E.

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N2 - Dual-chamber cardiac pacing (DDD) offers obvious theoretical advantages over traditional ventricular demand (VVI) pacing. Nevertheless, no widely agreed upon criteria exist for the selection of patients for physiologic DDD pacemakers compared with the simpler VVI systems. Accordingly, a non-invasive method for measuring cardiac output (Doppler ultrasound) was used to identify candidates for pacing who would derive the greatest hemodynamic benefit from DDD vs VVI pacing. Among 29 patients studied at rest during VVI-mode pacing, the average cardiac output by Doppler ultrasound was 4.3 ±0.3 liters/min (mean ± standard error of the mean). In the DDD mode, the average cardiac output was 5.0 +- 0.3 liters/min (p <0.001). Baseline left ventricular ejection fraction did not identify a group that improved more with DDD pacing. Patients who showed either retrograde ventriculoatrial conduction or described symptoms consistent with the "pacemaker syndrome" during VVI pacing, however, showed greater increases in cardiac output during DDD pacing. In these patients, the mean improvement in cardiac output was 30.4 ± 8.6% with DDD vs VVI pacing, as opposed to an average increase of only 14.4 ± 3.4% in the remaining 20 patients (p = 0.02). Thus, Doppler ultrasound can be used to quantitate the change in cardiac output at rest that occurs with DDD vs VVI pacing. The change is independent of the level of left ventricular function but is substantially higher when there is evidence of ventriculoatrial conduction or the pacemaker syndrome.

AB - Dual-chamber cardiac pacing (DDD) offers obvious theoretical advantages over traditional ventricular demand (VVI) pacing. Nevertheless, no widely agreed upon criteria exist for the selection of patients for physiologic DDD pacemakers compared with the simpler VVI systems. Accordingly, a non-invasive method for measuring cardiac output (Doppler ultrasound) was used to identify candidates for pacing who would derive the greatest hemodynamic benefit from DDD vs VVI pacing. Among 29 patients studied at rest during VVI-mode pacing, the average cardiac output by Doppler ultrasound was 4.3 ±0.3 liters/min (mean ± standard error of the mean). In the DDD mode, the average cardiac output was 5.0 +- 0.3 liters/min (p <0.001). Baseline left ventricular ejection fraction did not identify a group that improved more with DDD pacing. Patients who showed either retrograde ventriculoatrial conduction or described symptoms consistent with the "pacemaker syndrome" during VVI pacing, however, showed greater increases in cardiac output during DDD pacing. In these patients, the mean improvement in cardiac output was 30.4 ± 8.6% with DDD vs VVI pacing, as opposed to an average increase of only 14.4 ± 3.4% in the remaining 20 patients (p = 0.02). Thus, Doppler ultrasound can be used to quantitate the change in cardiac output at rest that occurs with DDD vs VVI pacing. The change is independent of the level of left ventricular function but is substantially higher when there is evidence of ventriculoatrial conduction or the pacemaker syndrome.

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