Advertisement

Noninvasive Measurement of Atrial Contribution to the Cardiac Output in Children and Adolescents With Congenital Complete Atrioventricular Block Treated With Dual-Chamber Pacemakers

      The contribution of atrial contraction to cardiac output (CO) has been the subject of extensive research but has yet to be quantified adequately in children and adolescents. Patients with third-degree atrioventricular (AV) block treated with pacemakers (PMs) are ideal candidates to assess the atrial contribution to CO by repeated measurements in single-chamber pacing mode (VVIR) and dual-chamber pacing mode (DDD/VDD). Hemodynamic measurements in children are often complicated by technical restrictions, but more recently a noninvasive method involving inert gas rebreathing has become available, which is an excellent tool for this age group. We examined 10 patients (6 female patients, mean age 14.5 ± 2.5 years, range 11 to 18) with congenital complete AV block treated with dual-chamber PM. Using an inert gas rebreathing device (Innocor) we measured CO in DDD/VDD with optimized AV delays. Devices were subsequently set to VVIR with matched heart rates and after 20 minutes the CO measurement was repeated. Mean CO of 6.4 ± 1.8 L/min was significantly higher in DDD/VDD than in VVIR, where it averaged 5.2 ± 1.4 L/min (p <0.001). Fractional increase of CO gained through sequential ventricular contraction was 18% (p <0.001). In VVIR, 8 patients reported PM-related symptoms. In conclusion, our data strongly suggest that pediatric patients with congenital complete AV block may benefit from AV synchrony with respect to hemodynamics and tolerability. Therefore, preferred use of DDD/VDD with optimized AV conduction delays should be considered.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Richardson J.R.
        • Ferguson J.
        • Hiscox J.
        • Rawles J.
        Non-invasive assessment of cardiac output in children.
        J Accid Emerg Med. 1998; 15: 304-307
        • Chew M.S.
        • Poelaert J.
        Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature.
        Intensive Care Med. 2003; 29: 1889-1894
        • Agostoni P.
        • Cattadori G.
        • Apostolo A.
        • Contini M.
        • Palermo P.
        • Marenzi G.
        • Wasserman K.
        Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique: a new tool for heart failure evaluation.
        J Am Coll Cardiol. 2005; 46: 1779-1781
        • Sobanski P.
        • Sinkiewicz W.
        • Kubica J.
        • Blazejewski J.
        • Bujak R.
        The reliability of noninvasive cardiac output measurement using the inert gas rebreathing method in patients with advanced heart failure.
        Cardiology. 2008; 15: 63-70
        • Peyton P.J.
        • Thompson B.
        Agreement of an inert gas rebreathing device with thermodilution and the direct oxygen Fick method in measurement of pulmonary blood flow.
        J Clin Monit Comput. 2004; 18: 373-378
        • Saur J.
        • Fluechter S.
        • Trinkmann F.
        • Papavassiliu T.
        • Schoenberg S.
        • Weissmann J.
        • Haghi D.
        • Borggrefe M.
        • Kaden J.J.
        Noninvasive determination of cardiac output by the inert-gas-rebreathing method—comparison with cardiovascular magnetic resonance imaging.
        Cardiology. 2009; 114: 247-254
        • Schiller N.B.
        • Shah P.M.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittger I.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Koglek W.
        • Kranig W.
        • Kowalski M.
        • Stammwitz E.
        • Brandl J.
        • Oberbichler A.
        • Wutte M.
        • Grimm G.
        • Grove R.
        A simple method for determining the AV interval in dual chamber stimulation.
        Herzschr Elektrophys. 2004; 15: I/23-I/32
        • Nowak B.
        • Voigtlander T.
        • Himmrich E.
        • Liebrich A.
        • Poschmann G.
        • Epperlein S.
        • Treese N.
        • Meyer J.
        Cardiac output in single-lead VDD pacing versus rate-matched VVIR pacing.
        Am J Cardiol. 1995; 75: 904-907
        • Stefanadis C.
        • Dernellis J.
        • Toutouzas P.
        A clinical appraisal of left atrial function.
        Eur Heart J. 2001; 22: 22-36
        • Stewart W.J.
        • Dicola V.C.
        • Harthorne J.W.
        • Gillam L.D.
        • Weyman A.E.
        Doppler ultrasound measurement of cardiac output in patients with physiologic pacemakers.
        Am J Cardiol. 1984; 54: 308-312
        • Connolly S.J.
        • Kerr C.
        • Gent M.
        • Yusuf S.
        Dual-chamber versus ventricular pacing.
        Circulation. 1996; 94: 578-583
        • Horenstein M.S.
        • Karpawich P.P.
        • Tantengco M.V.
        Single versus dual chamber pacing in the young: noninvasive comparative evaluation of cardiac function.
        Pacing Clin Electrophysiol. 2003; 26: 1208-1211
        • Ovsyshcher I.E.
        Toward physiological pacing: optimization of cardiac hemodynamics by AV delay adjustment.
        Pacing Clin Electrophysiol. 1997; 20: 861-865
        • Baspinar O.
        • Celiker A.
        • Karagoz T.
        Cardiac index and exercise during VDD/DDD versus VVIR pacing in children.
        Cardiology. 2007; 107: 185-189
        • Schuller H.
        • Brandt J.
        The pacemaker syndrome: old and new causes.
        Clin Cardiol. 1991; 14: 336-340
        • Rediker D.E.
        • Eagle K.A.
        • Homma S.
        • Gillam L.D.
        • Harthorne J.W.
        Clinical and hemodynamic comparison of VVI versus DDD pacing in patients with DDD pacemakers.
        Am J Cardiol. 1988; 61: 323-329
        • Sulke N.
        • Chambers J.
        • Dritsas A.
        • Sowton E.
        A randomized double-blind crossover comparison of four rate-responsive pacing modes.
        J Am Coll Cardiol. 1991; 17: 696-706

      Linked Article

      • The Indication for Pacemakers in Children Should Be Symptoms, Not Resting Hemodynamics
        American Journal of CardiologyVol. 107Issue 8
        • Preview
          Hauser et al1 nicely confirmed, in young subjects with complete atrioventricular block, that dual-chamber sequential pacing increased rest cardiac output, using a noninvasive, inert gas rebreathing method. However, their conclusion went beyond their protocol to suggest that this would benefit “hemodynamics and tolerability” in these patients. They did not measure exercise capacity, and tolerability was measured only in “pacemaker-related symptoms” tested acutely.
        • Full-Text
        • PDF