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pacemaker compromises the heart

added by Emmel

pacemaker compromises the heart
Posted By: Emmel (2272 days ago)

Hello Pablo!
This patient got a DDDR pacer after 3 days of
passagere VVI-pacer-implantation. You´re right! haemodynamic didn´t
decrease very much when pacer worked.
Thanks for your answer and


Posted By: ohtusabes (2272 days ago)

Very good question.
The asyncrony is tipical of RV pacemaker
stimulation and of course, the hemodynamic is worse and predisposes
patients to AF.
But, more than CRT I will consider DDDR
stimulation (If AV conduction is good)because with VVI the atrial kick
(if exists)is made asynchronous with opening of tricuspid valve and,
with, 85 yo 30-25 % of LV filling is lost. Of course, this is not a
solution to asynchrony but cardiac output maybe is better./>Best,

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Added: 02-01-2012
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about 85 y old patient with bradycardia-tachycardia-syndrom and congestive heart failure. In context of asystolia we implantated a passagere VVI-pacemaker. In TEE we could see that there is a deterioration of cardiac wall movement with decrease of haemodynamic (decrease of blood pressure, decrease of pw-flow in LVOT) during right ventricular pacemaker-stimulation. In ECG during intrinsic heartbeat there is NO broad QRS-complex, the left ventricular ejection fraction is about 30-35%. What can we do? Make it sence to implantate a CRT to avoid an asynchronuous stimulation with compromise of haemodynamic (NO broad QRS-complex < 100 msec; EF 30-35%!)?

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