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      Cardiac Index and Exercise during VDD/DDD versus VVIR Pacing in Children

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          Twelve children with a VDD/DDD pacemaker during 100, 125, 150, 200 ms atrioventricular delays and VVIR pacing, cardiac index was measured at rest and evaluated by endurance time during exercise stress test. The optimal atrioventricular delay, which provides highest cardiac index, was 100 ms in three, 125 ms in two, and 150 ms in four and 200 ms in three patients. VDD/DDD pacing with different atrioventricular intervals resulted in a significantly higher cardiac index (6.70 ± 3.06, 6.49 ± 2.51, 6.15 ± 2.35, 6.37 ± 2.69 l/min/m<sup>2</sup>, respectively) than VVIR pacing (5.25 ± 2.39 l/min/m<sup>2</sup>) at the rest. However, endurance times to treadmill exercise were similar in both the optimal atrioventricular delay (21.6 ± 3.7 min) and VVIR mode (22.4 ± 3.4 min) (p > 0.05).

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          Most cited references 17

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          Optimizing the AV delay in DDD pacemaker patients with high degree AV block: mitral valve Doppler versus impedance cardiography.

          In DDD-pacemaker patients with high degree AV block, Doppler echocardiography of transmitral blood flow can be used to find the individually optimal AV delay (AVO) for left heart AV synchronization. This study tried to validate a Doppler method (ECHO) recently proposed to optimize left ventricular filling by comparing it to stroke volume data derived from impedance cardiography (ICG). It should be further elucidated if optimizing the AV delay (AVD) by means of this method is superior to fixed AVD settings and which differential AVD (pace-sense-offset) should be programmed for atrially triggered (ATP) and AV sequential (AVP) pacing, respectively. AVO as measured in 53 patients showed a linear correlation between ECHO and ICG for both ATP (r = 0.66, P < 0.00001) and AVP (r = 0.53; P < 0.005). The mean deviation in AVO between ECHO and ICG was +/- 26 ms (ATP) and +/- 30 ms (AVP), respectively, with a tendency to longer AVDs with the Doppler method. ECHO limitations could mainly be attributed to: (1) restrictions of AVD programming options (which may be compensated for by slight modification of the proposal); and (2) to pathophysiological mechanisms that alter mitral valve dynamics. Optimization of the AVD by Doppler produced a stroke volume that was significantly higher (19%) than with a fixed AVD (150 ms in ATP; 200 ms in AVP). There was a wide scatter in pace-sense-offsets between-7 and 134 ms, which was reflected by both methods. It is concluded that AVO determinations by ECHO are valid provided that methodological pitfalls and limitations caused by the disease are recognized. Tailoring AVD with respect to diastolic filling improves systolic function and is superior to nominal AVD settings. Fixed differential AVDs as offered by some manufacturers are far from being physiological. Thus modern pulse generators should offer free programmability over a wide range of AV delays.
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            Congenital complete atrioventricular block.

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              Toward physiological pacing: optimization of cardiac hemodynamics by AV delay adjustment.

               I Ovsyshcher (1997)

                Author and article information

                S. Karger AG
                March 2007
                28 August 2006
                : 107
                : 3
                : 185-189
                Department of Pediatric Cardiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
                95345 Cardiology 2007;107:185–189
                © 2007 S. Karger AG, Basel

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                Figures: 1, Tables: 2, References: 21, Pages: 5
                Original Research


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