Similar pattern of diastolic function adaptation of both ventricles to programmed atrioventricular interval modification in patients with DDD pacing.

OBJECTIVE: To evaluate both left ventricular (LV) and right ventricular (RV) diastolic performance adaptation to variable atrioventricular interval (AVI), in patients with DDD pacing for complete heart block and to investigate a possible interaction between LV and RV in this specific cohort of patients.

METHODS: We studied 22 consecutive patients (mean age 65.2 +/- 14.3 years) who underwent DDD pacemaker implantation following admission for complete heart block. One day following implantation, patients were paced at 3 different pacing modes, under the same programmed heart rate and a different AVI (100, 150 and 200 ms respectively). Standard Doppler echocardiography of mitral and tricuspid valve inflow was performed to evaluate LV and RV diastolic function, during each pacing mode.

RESULTS: Left ventricular and RV diastolic performance adaptation to variable AVI modifications was similar, showing a progressive increase of late diastolic filling velocities and a subsequent decrease of E/A wave ratios following AVI prolongation. A short AVI of 100 or 150 ms was associated with improved LV and RV diastolic filling dynamics.

CONCLUSIONS: In elderly patients with complete heart block and unimpaired systolic function undergoing DDD pacemaker implantation, both ventricles share a similar pattern of diastolic function adaptation to AVI modifications and that might be the reflection of ventricular interaction under this specific pacing mode.