Abstract
The maintenance of adequate cardiac output during both rest and stress is determined by a complex interaction between cardiac contraction and relaxation, itself dependent on a normal sequence of cardiac activation on account of its interface through excitation-contraction coupling. Studying the effects of various conduction abnormalities on this relationship is central to understanding how pacing can restore as well as alter cardiac hemodynamics, with both negative and positive impacts on morbidity and mortality. This chapter discusses the hemodynamic determinants of effective pacemaker function, including pacing site, atrial conduction delay, atrioventricular and ventriculoatrial conduction, and the various pacing modes, as well as how to best optimize the hemodynamic response to pacing. Also discussed is the extension of pacing from restoration of heart rate alone to maintaining ventricular synchrony in heart failure, increasing cardiac contractility through cardiac contractility modulation pacing, and treating hypertrophic obstructive cardiomyopathy and neurocardiogenic syndrome. The chapter incorporates new data available from clinical trials conducted since the last publication and updates our understanding of determinants of response to and optimization of cardiac resynchronization therapy. Also discussed are advances in our understanding of the effects of pacing on atrial mechanical function, mitral regurgitation, diastolic function and right ventricular function made possible from new cardiac imaging techniques.
Original language | English (US) |
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Title of host publication | Cardiac Pacing, Defibrillation and Resynchronization |
Subtitle of host publication | A Clinical Approach |
Publisher | Wiley-Blackwell |
Pages | 41-92 |
Number of pages | 52 |
ISBN (Print) | 9780470658338 |
DOIs | |
State | Published - Dec 17 2012 |
Keywords
- AV (atrioventricular) optimization
- Cardiac resynchronization therapy
- Dyssynchrony
- Hemodynamics
- Left atrial pacing
- Pacemaker syndrome
- Pacing mode
- V-V optimization
ASJC Scopus subject areas
- General Medicine