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European Heart Journal 1992 13(7):914-917;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Comparison of DDD and‘VVI-R like’ pacing during moderate exercise: echo-Doppler study

G. LASCAULT*,, R. FRANK*, T. IWA*, S. GIRODO{dagger}, G. FONTAINE* and Y. GROSGOGEAT*

*Service de Cardiologie, Hôopital Jean Rostand 39–41 Rue Jean Le Gaileu, 94200 Ivry Sur Seine, France
{dagger}ELA Medical 98 Rue Maurice Arnoux, 92120 Montrouge, France

Received 25 January 1991; revised 27 September 1991; .

Correspondence: Dr Lascault, Service de Cardiologie, Hôpital Jean Rostand, 39–41 Rue Jean Le Galleu, 94200 Ivry Sur Seine, France.

Abstract

The non-invasive haemodynamic comparisons of DDD and ‘VVI-R like’ pacing at rest and during moderate exercise by echo Doppler are reported. Twelve patients (six males, six females, mean age 48.2 years) with a dual chamber pacemaker were submitted to a series of two exercise tests in a semi-supine position, the first test in DDD mode and the second test in a ‘VVI-R like’ mode: VVTmode, during which pacing rate was externally increased by chest wall stimulation. During the second test, the workload profile was matched to that of the first test (66 watts and same exercise stages) and ventricular pacing rate was incremented via chest wall stimulation and reproduced exactly the heart rate profile of the first test in DDD mode. The heart rate averaged 81 beats.min–1 at rest and reached 116 beats.min–1 during exercise. At rest and throughout exercise tests, aortic blood flow velocity spectra were continuously recorded on video tape and analysed with the calculation program of the echocardiograph. At rest, ejection time, flow velocity integral, flow acceleration and stroke volume differed between DDD and ’VVI-R like‘ mode while other parameters did not. During exercise all but two parameters differed. DDD mode especially was associated with a larger stroke volume (81.9 vs 70.9 ml; P <0.001) and cardiac output (9.24 vs 8.011. min–1; P < 0.001) than VVI-R mode. Flow acceleration and acceleration time were similar during exercise in both modes, suggesting that the haemodynamic superiority of DDD was not due to a higher level of contractility, but to a higher level of preload secondary to the preserved atrial systole during exercise.

Key Words: DDD pacing • VVI-R pacing • exercise Doppler • echo Doppler


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