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The Acute Effect of Cardiac Pacing Mode on Endothelial Vasodilation: Prospective, Double‐Blind, Cross‐Over, Comparative Clinical Study
Author(s) -
FAK ALI SERDAR,
OZBEN BESTE,
TOPRAK AHMET,
CINCIN A. ALTUG,
PAPILA NURDAN,
TANRIKULU M. AZRA,
OKTAY AHMET
Publication year - 2008
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2008.00993.x
Subject(s) - medicine , vasodilation , cardiology , double blind , placebo , alternative medicine , pathology
Background: Compared to atrioventricular sequential pacing, ventricular demand pacing is known to have somewhat more deleterious hemodynamic effects, which probably arise from increased sympathetic tonus and inappropriate baroreceptor activation. Endothelial function is affected by various local and systemic factors including baroreceptor activity. The aim of this study was to explore whether cardiac pacing would have any effect on endothelial functions.Methods: Twelve patients (six male, mean age: 75 ± 9 years) with previously implanted DDD or VDDcardiac pacemakers were included. All patients had stable atrial rhythms during the study. Patients were randomized to either atrial‐based pacing mode (VDD or DDD) or ventricular demand pacing mode (VVI) first, and then cross‐over was performed with the other pacing mode. Endothelial function was assessed by brachial artery ultrasonography. Basal diameter of the brachial artery, and both flow‐mediated dilation (FMD) and endothelium‐independent vasodilation with nitroglycerin were measured 1 hour after each pacing mode.Results: Compared to atrial‐based pacing mode, ventricular demand pacing was associated with a significantly worse FMD both as absolute and percentage values (0.17 ± 0.09 mm vs 0.28 ± 0.11 mm, P = 0.015 and 4.84 ± 2.37 % vs 7.00 ± 2.88 %, P = 0.028, respectively). However, there was no significant difference in nitroglycerin‐mediated vasodilation values between the two pacing sessions.Conclusions: Acute ventricular demand pacing (VVI pacing) is clearly associated with attenuation of FMD in patients with atrial‐based pacing systems. The attenuation of endothelial vasodilation might have a role in hemodynamic and clinical deterioration in patients with VVI pacemakers.