Author + information
- Received October 4, 1983
- Revision received April 3, 1984
- Accepted April 17, 1984
- Published online September 1, 1984.
- Sanjeev Saksena, MD, FACC*,1,
- John M. Ciccone, MD1,
- William Craelius, PhD1,
- Demetrius Pantopoulos, ME1,
- Stephen T. Rothbart, MD1 and
- Roland Werres, MD, FACC1
- ↵*Address for reprints: Sanjeev Saksena, MD, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, New Jersey 07112.
The acute effects of rapid ventricular pacing and sustained ventricular tachycardia on left ventricular function were examined in patients with recurrent sustained ventricular tachycardia. Programmed electrical stimulation and left ventricular hemodynamic measurements were performed in 20 patients (19 men and 1 woman), with an age range of 49 to 79 years (mean 63 ± 9). Indexes of left ventricular function that were analyzed included left ventricular peak systolic pressure, end-diastolic pressure, first derivative of peak left ventricular pressure (dP/dt) and negative left ventricular dP/dt. Measurements were obtained during sinus rhythm, after paced premature ventricular depolarizations, during rapid ventricular pacing (cycle lengths 600 to 250 ms) and immediately after induction of sustained ventricular tachycardia.
Mean left ventricular peak systolic blood pressure was 123 ± 19 mm Hg during sinus rhythm, decreased to 77 ± 23 mm Hg (p < 0.05) at the induction of ventricular tachycardia and remained decreased during arrhythmia (p < 0.01). Mean left ventricular end-diastolic pressure was 22 ± 5 mm Hg during sinus rhythm, did not change after arrhythmia induction (22 ± 9 mm Hg, p > 0.2) and remained unchanged during sustained ventricular tachycardia (p > 0.2). Mean peak left ventricular dP/dt was 1,400 ± 620 mm Hg/s in sinus rhythm, decreased to 810 ± 580 mm Hg/s (p < 0.05) at ventricular tachycardia induction and remained decreased during sustained ventricular tachycardia (p < 0.01). Mean negative left ventricular dP/dt was 1,220 ± 520 mm Hg/s during sinus rhythm, decreased to 525 ± 270 mm Hg/s after ventricular tachycardia induction and remained decreased during sustained ventricular tachycardia (p < 0.05). Late ventricular premature depolarizations resulting in fusion beats showed left ventricular peak systolic blood pressure, left ventricular end-diastolic pressure and peak dP/dt similar to those of the sinus beat, but negative dP/dt decreased. With increasingly premature ventricular depolarizations, systolic function was decreased and diastolic relaxation was further compromised. Rapid ventricular pacing performed at cycle lengths comparable with ventricular tachycardia cycle lengths produced equivalent changes in left ventricular hemodynamics.
A multivariate analysis showed correlation between left ventricular systolic pressure during ventricular tachycardia and ventricular tachycardia cycle length (p < 0.05). Decreasing systolic left ventricular function during ventricular tachycardia is dependent on left ventricular filling, which is further compromised by impaired diastolic left ventricular relaxation resulting from abnormal contraction patterns.
- Received October 4, 1983.
- Revision received April 3, 1984.
- Accepted April 17, 1984.
- American College of Cardiology Foundation