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Objective To evaluate the acute hemodynamic effects of AM, VVI and DDD pacing. Method 14. patients with symptomatic sick sinus syndrome were tested during pacemaker implantation :9 patients were found with venlriculoaUial conduction (group 1) and 5 patients without it (group 2). Mean right aUial pressure (RAP) , mean pulmonaiy aitely pressure (PAP) and mean pulmonaiy capilaiy wedge pressure (PCWP) were measured by Swan - Ganz catheterization, cardiac output (CO) was detemiined by the thennodilution technique, mean aitery pressure (MAP) was measured by no - invasive way. Pressures and CO were measured at spontaneous rhythm as baseline and during AAI , VVI and DDD pacing. Results (I) No significant difference in MAP was observed among the three pacing modes and spontaneous rhythm . (~) During AM, DDD pacing, no significant changes were observed for RAP , PAP , PCWP compared with spontaneous rhythm, but CO significantly increased (p<O.O1). There was no significant difference in PAP,RAP,PCWP,CO between AM and DDD pacing,but there was a tendency for higher CO in AAI.瓵AI,DDD mode improved most hemodynamic parameters compared with VVI mode: 3 CO significantly increased (p <0.01); PAP, RAP, PCWP significantly decreased (p<O.01).(4) During VVL pacing,the change in CO from the baseline was towards decrease in group 1 (no statistically significance) and towards increase in group 2 (o <0.05); RAP , PAP, PCWP significantly increased from the baseline in both groups (p < 0.05).C~)The RAP,PAP,PCWP were higher and CO was lower in group 1 than group 2, these difference between the groups was significant (p < 0.05). Conclusion Physiological pacing especially AAL is hemodynaniically superior both to VVI and to spontaneous rhythm and should be prefened in symptomatic sick sinus syndrome patients. Those patients who want to select VVI pacing should consider ventriculoatrial conduction which can deteriomte cardiac performance.
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