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Effects of Pacing Modes on Cardiac Baroreflex Function in Permanently Paced Patients with Sinus Node Dysfunction

Authors

  • TAKUO TSURUGI M.D.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • HARUHIKO ABE M.D., F.A.C.C.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • YASUSHI OGINOSAWA M.D.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • RITSUKO KOHNO M.D.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • TOMIYA YASUMASU M.D.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • TOSHIHISA NAGATOMO M.D.,

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • YUTAKA OTSUJI M.D., F.A.C.C.

    1. From The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • This study was supported in part by a Grant-in-Aid for Research on Occupational Safety from the Ministry of Health, Labor and Welfare, Japan.

  • Manuscript received 8 September 2007; Revised manuscript received 6 December 2007; Accepted for publication 18 December 2007.

Address for correspondence: Haruhiko Abe, M.D., F.A.C.C., The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan. Fax: +81-93-691-6913; E-mail: haru-abe@med.uoeh-u.ac.jp

Abstract

Objectives: We compared, in patients with sick sinus syndrome, the effects of various pacing modes on baroreceptor (BR)-stroke volume (SV) reflex sensitivity, a method we have closely correlated with BR-heart rate (HR) reflex sensitivity.

Background: Impaired autonomic nervous function, such as decreased BR-HR reflex sensitivity, predicts sudden cardiac death. However, in patients with sick sinus syndrome, the effects of various pacing modes on autonomic function are unknown, since chronotropic incompetence precludes its evaluation by measurements of BR-HR reflex sensitivity.

Methods: We studied 12 recipients of dual-chamber pacemakers with sick sinus syndrome (mean age = 73 ± 8 years; 8 men). Beat-by-beat blood pressure (BP) and SV were measured during 5-minute runs of AAI, DDD, and VVI pacing, and spectrally analyzed to assess BR-SV reflex sensitivity.

Results: Systolic BP was significantly lower (P < 0.01) during VVI (109 ± 24 mmHg) than during DDD (124 ± 22 mmHg) or AAI (125 ± 41 mmHg) pacing. SV was significantly smaller during VVI (36 ± 23 mL) than during DDD (49 ± 31 mL) pacing (P < 0.05). BR-SV reflex sensitivity was significantly lower (P < 0.05) during VVI (9.3 ± 5.7% per mmHg) than during DDD (15.0 ± 6.5% per mmHg) or AAI (15.5 ± 6.2% per mmHg) pacing.

Conclusions: BR-SV reflex sensitivity was significantly lower during VVI than during AAI or DDD pacing. Atrioventricular synchrony plays an important role in the preservation of BR-SV reflex sensitivity in pacemaker recipients.

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