The Influence of Different AV Delays on Left Ventricular Diastolic Functions and on Incidence of Diastolic Mitral Regurgitation

Abstract

In patients with a DDD pacemaker (PM), programming of atrioventricular (AV) delay can influence ventricular filling and function. In this study the authors used color Doppler echocardiography to evaluate the effect of different AV delays on left ventricular diastolic function (LVDF) and on the incidence of diastolic mitral regurgitation.

In 26 patients with DDD PM, the following parameters were evaluated during five different AV delays by echocardiography: (1) mitral E wave amplitude (by pulsed Doppler), (2) mitral A wave amplitude (by pulsed Doppler), (3) isovolumetric relaxation time (IVRT), (4) deceleration time (DT), (5) LV diastolic dimension (LVDd), (6) LV systolic dimension (LVDs), (7) ejection fraction (EF), and (8) diastolic mitral regurgita tion (DMR). Patients had been paced for symptomatic AV block (n: 16, 62%) and sick sinus syndrome (n: 10, 38%). Mean age of patients was fifty-two (nineteen to sixty- three) and 13 (50%) of them were women. (continued on next page)

Correlation was sought between AV delay and investigated parameters. The correla tion coefficients of AV delay and E wave, A wave, IVRT, DT, LVDd, LVDs, and EF were -0.137, 0.243, 0.541, 0.031, 0.210, 0.241, and -0.184 respectively. DMR was detected in all cases when AV delay was increased more than 150 msec.

In conclusion, a slight correlation was found between AV delay and IVRT (r: 0.541). Other parameters of LV diastolic and systolic function did not correlate with AV delay. Second, DMR was observed in all patients when the AV delay was prolonged more than 150 msec.

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References

Dougherty AH , Naccarelli GV , Gray EL , et al: Congestive heart failure with normal systolic function. Am J Cardiol 54:778-782, 1984.

Ishikawa T. , Kimura K. , Miyazaki N. : Diastolic mitral regurgitation in patients with first-degree atrioventricular block. PACE 15:1927-1930, 1992 .

Gamble WH , Shaver JA , Alvares RF , et al: A critical appraisal of diastolic time intervals as a measure of relaxation in left ventricular hypertrophy. Circulation 68:76-87, 1983.

Danfort DA , Huhta JC , Murphy DJ : Doppler echocardiographic approaches to ventricular diastolic function. Echocardiography 3:33-36, 1986.

Rockey R. : Influence of atrial emptying on early left ventricular filling dynamics (abstract) . J Am Coll Cardiol 5:510A-513A, 1985.

Nolan SP , Dixon SH , Fisher RD , et al: The influence of atrial contraction and mitral valve mechanics on ventricular filling. Am Heart J 77:784-791, 1969.

Freedman RA , Yock PG , Echt DS , et al: Effect of variation in PQ interval on patterns of atrioventricular valve motion and flow in patients with normal ventricular function. J Am Coll Cardiol 7:59-62, 1986.

Ishikawa T. , Kimmura K. , Nihei T. , et al: Relationship between diastolic mitral regurgitation and PQ intervals or cardiac function in patients with implanted DDD pacemakers. PACE 14:1797-1802, 1991.