Efficacy of Atrioventricular Sequential Pacing and Diastolic Mitral Regurgitation in Patients With Intrinsic Atrioventricular Conduction
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概要
- 論文の詳細を見る
The efficacy of a short strioventricular (AV) delay in patients with dilated cardiomyopathy has been reported, but there are deleterious effects of right ventricular pacing. Diastolic mitral regurgitation (MR) is observed in patients with elevated left ventricular end-diastolic pressure and can be induced by prolonging the AV delay in patients with DDD pacemakers. The critical PQ interval that induces diastolic MR may represent the upper limit of the optimal PQ interval. The efficacy of AV sequential pacing and diastolic MR were studied in 11 patients (68.3±13.7 (SD) years old) with intrinsic AV condition and with implanted DDD pacemakers. Cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) were measured by Swan-Ganz catheter and transmitral flow was recorded by pulsed Doppler echocardiography. AV delay was prolonged stepwise by 25ms starting from 65ms. Pacing rate was fixed at 70-80 beats/min. In 6 of the 11 patients, diastolic MR was observed under atrial pacing and the critical PQ interval for the appearance of diastolic MR was 0.22±0.04s. CO was increased from 3.8±0.8 to 4.3±0.9 L/min (p<0.05) and PCWP was decreased from 7.5±2.8 to 5.5±1.6 mmHg (p<0.05) by shortening the AV delay till the diastolic MR disappeared. On the other hand, in 5 of the 11 patients, diastolic MR was not observed, and CO (4.2±0.5 to 4.3±0.5 L/min, ns) and PCWP (5.8±4.6 to 5.4±3.9 mmHg, ns) were not improved by AV sequential pacing. In conclusion, cardiac function may be improved by AV sequential pacing and setting the AV delay under the critical PQ interval for the appearance of diastolic MR when the diastolic MR is observed. However, AV sequential pacing may be either ineffective or even deleterious for patients in whom diastolic MR is not observed.
- 社団法人日本循環器学会の論文
- 2000-07-20
著者
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Ishikawa Toshiyuki
Second Department of Internal Medicine, Yokohama City University Hospital
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Sumita Shinichi
Second Department of Internal Medicine, Yokohama City University Hospital
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Kosuge Masami
Second Department of Internal Medicine, Yokohama City University Hospital
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Kimura Kazuo
Second Department of Internal Medicine, Yokohama City University Hospital
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Umemura Satoshi
Second Department of Internal Medicine, Yokohama City University Hospital
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Kosuge Masami
横浜市立大学附属市民総合医療センター 心臓血管センター
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Kosuge Masami
Yokohama City University School Of Medicine Cardiovascular Center
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Sumita Shinichi
Second Department Of Internal Medicine Yokohama City University Hospital
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Usui Takashi
Department of Cardiology, Fujisawa Municipal Hospital
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Usui Takashi
Department Of Cardiology Fujisawa Municipal Hospital
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Minami Kazutoshi
Yokohama City University Medical Center
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Kosuge Masami
横浜市立大学 心臓血管セ
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Nakagawa Takeshi
Second Department of Internal Medicine, Yokohama City University Hospital
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Usui Takashi
Second Department of Internal Medicine, Yokohama City University School of Medicine
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Umemura Satoshi
Second Department Of Internal Medicine Yokohama City University School Of Medicine
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Kikuchi Miyako
Second Department of Internal Medicine, Yokohama City University School of Medicine
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Matsushita Kohhei
Second Department of Internal Medicine, Yokohama City University School of Medicine
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Ishikawa Toshiyuki
Second Department Of Internal Medicine Yokohama City University Hospital
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Kikuchi Miyako
Yokohama City University School Of Medicine Cardiovascular Center
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Kikuchi Miyako
Second Department Of Internal Medicine Yokohama City University
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Nishizawa Takashi
Department Of Pediatrics Yokohama City University Medical Center
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Kimura Kazuo
Second Department Of Internal Medicine Yokohama City University School Of Medicine
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