Document Detail


Orthostatic responses in patients with DDD pacemakers: signs of autonomic dysfunction.
MedLine Citation:
PMID:  1279575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Responses to orthostasis may be altered in states associated with autonomic dysfunction. Computerized impedance cardiography, a noninvasive method for continuous assessment of stroke volume and mean blood pressure, was utilized to study the postural hemodynamic changes in eight normal and 27 patients with DDD pacemakers. Twenty patients with complete heart block (five with heart failure) were studied in the VDD mode and seven patients with sick sinus syndrome were assessed in DVI (four) or VDD (three). The results with pacemaker patients are significantly different from those observed in normal. Pacemaker patient responses to standing included: (1) a reduction in systolic, diastolic, and mean blood pressure; (2) an increase in heart rate in patients with intact sinus node function and no change in patients with sick sinus syndrome; and (3) stroke volume was unchanged in patients with sick sinus syndrome or heart failure and only modest reduction occurred in the remaining patients. Conclusions: (1) No reduction in stroke volume during upright posture occurs in DDD patients with sick sinus syndrome and this appears to be a compensatory reaction to an inadequate heart rate response to standing; (2) The hemodynamic response of DDD patients to the assumption of an upright posture is consistent with autonomic dysfunction; and (3) The primary cause for autonomic dysfunction in DDD patients may be the asynchronous ventricular depolarization caused by right ventricular pacing.
Authors:
I Ovsyshcher; J N Gross; S Blumberg; S Furman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  15     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1992 Nov 
Date Detail:
Created Date:  1992-12-16     Completed Date:  1992-12-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1932-6     Citation Subset:  IM; S    
Affiliation:
Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York.
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MeSH Terms
Descriptor/Qualifier:
Aged
Autonomic Nervous System Diseases / diagnosis,  etiology,  physiopathology*
Blood Pressure / physiology
Cardiac Pacing, Artificial / methods
Cardiography, Impedance
Female
Heart Block / therapy*
Hemodynamics / physiology*
Humans
Male
Pacemaker, Artificial*
Posture / physiology*
Sick Sinus Syndrome / therapy*
Stroke Volume / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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