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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >The acute effect of cardiac pacing mode on endothelial vasodilation: prospective, double-blind, cross-over, comparative clinical study.
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The acute effect of cardiac pacing mode on endothelial vasodilation: prospective, double-blind, cross-over, comparative clinical study.

机译：心脏起搏模式对内皮血管舒张的急性影响：前瞻性，双盲，交叉，比较临床研究。

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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 vasodilationwith 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.
机译：背景：与房室顺序起搏相比，已知心室起搏具有更有害的血液动力学效应，这可能是由于交感神经张力增加和压力感受器激活不适当引起的。内皮功能受各种局部和全身因素的影响，包括压力感受器的活动。这项研究的目的是探讨心脏起搏是否会对内皮功能产生任何影响。方法：包括十二名先前植入了DDD或VDD心脏起搏器的患者（六名男性，平均年龄：75 +/- 9岁）。在研究期间，所有患者的心律均稳定。患者被随机分为基于心房的起搏模式（VDD或DDD）或心室需求起搏模式（VVI），然后与其他起搏模式进行交叉。通过肱动脉超声检查评估内皮功能。在每个起搏模式后1小时，测量肱动脉的基础直径，流量介导的扩张（FMD）和使用硝酸甘油的内皮依赖性血管舒张。结果：与基于心房的起搏模式相比，心室起搏与绝对值和百分比值的FMD均显着差（0.17 +/- 0.09 mm对0.28 +/- 0.11 mm，P = 0.015和4.84 +/- 2.37 ％vs 7.00 +/- 2.88％，P = 0.028）。然而，在两个起搏阶段之间，硝酸甘油介导的血管舒张值没有显着差异。结论：急性心室起搏（VVI起搏）显然与基于心房起搏系统的FMD衰减有关。血管内皮舒张功能的减弱可能与VVI起搏器的血液动力学和临床恶化有关。

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