Acute changes in left ventricular volume and contractility during ventricular pacing in patients with complete heart block.

Abstract

To determine whether changes in preload and contractility may account for clinical improvement in patients with complete heart block (CHB) when the ventricular rate is increased by pacing, 10 hemodynamic studies were performed in nine patients with CHB. Left ventricular end-diastolic volume (EDV) was measured before and during pacing by the dye-dilution and the angiographic techniques. Changes in contractility were assessed from the first derivative of ventricular pressure divided by a common peak isovolumic pressure (CPIP) to correct for afterload and by EDV to correct for preload. EDV decreased during pacing, the mean value decreasing from 242 to 180 ml ( P < 0.001). Since the left ventricular dp/dt is influenced by afterload and preload, improvement in contractility indices was consistent only after allowances were made for changes in aortic diastolic pressure and EDV. The mean dp/dt/CPIP divided by EDV increased from 0.120 to 0.160 ( P < 0.005). The mean left ventricular enddiastolic pressure decreased from 17.0 to 9.7 mm Hg ( P < 0.05) during pacing, while the mean cardiac index increased from 2.0 to 2.5 liters/min/m 2 ( P < 0.025). The clinical improvement seen after pacing in patients with CHB results, in part, from an increase in contractility and a decrease in EDV and pressure.