A case with much larger ballistocardiographic forces evoked by beats of pacemaker than by those of sinus origin

Abstract

In a patient with intermittent heart block, very large forces shaking the body in all three planes were recorded during runs of beats activated by a transvenous pacemaker. Much smaller forces were noted during runs of sinus rhythm, faster but with more forceful carotid pulses. Phonocardiograms and jugular pulse tracings excluded A-V reflux as a cause of the huge forces shaking the body in systoles of pacemaker origin with a prolonged QRS interval and reduced systolic ejection. It is concluded that aberrant activation of the left ventricle can lead to altered pull on the annulus and mediastinum, shaking the body with a resulting waste of myocardial energy. Similar effects probably occur in some ventricular ectopic beats, in ventricular tachycardia and in some types of left bundle branch block. When runs of sinus rhythm are escaping from heart block with pacemakers, pacing should be set at the slowest rate which will prevent syncope or ectopic rhythms. Thus sinus rhythm, with more effective systolic contractions, will be present as much of the time as possible.