ABSTRACT
Fifteen hypertensive patients (13 men) with left ventricular hypertrophy, mean age 69 6 5 years, having complete heart block and paced in the DDD mode, were studied by two-dimensional and Doppler echo in 100 and 200 ms atrioventricular delays. ANF plasma levels were measured at rest and at peak exercise, during pacing with the two different atrioventricular delays. ANF plasma levels were significantly higher at pacing with long atrioventricular delays (200 ms), at rest (152.47 6 12.38 pg/mL vs 119 6 12.38 pg/mL, P, 0.001) and at exercise (180.93 6 11.51 vs 123.67 6 16.24 pg/mL, P, 0.0001). ANF plasma levels were significantly increased at exercise, compared to those at rest during pacing with the two different atrioventricular delays, but we found a more pronounced increase of ANF levels (from 152.47 6 10.49 pg/mL to 180.93 6 11.51 pg/mL), when the atrioventricular delays was set to 200 ms (P, 0.0001). A significant decrease of isovolumic relaxation time (from 123.33 6 20.5 to 105.33 6 11.06 ms, P, 0.001) was observed, during pacing with the short atrioventricular delays. Moreover, the peak early (E) to peak atrial (A) velocity ratio (E/A) was declined (from 0.89 6 0.7 to 0.57 6 0.18, P, 0.05). We also noticed that patients with small left ventricles exhibit greater increase in ANF plasma levels during DDD pacing with long atrioventricular delays (r 5 20.792, P 5 0.000). In conclusion, left ventricular diastolic function of our patients seems to be improved during DDD pacing with short (100 ms) atrioventricular delays, as it was expressed by echocardiographic and hormonal measurements.
Subject(s)
Activities of Daily Living , Atrial Natriuretic Factor/blood , Atrioventricular Node/physiopathology , Cardiac Pacing, Artificial/methods , Hypertension/complications , Physical Exertion/physiology , Ventricular Function, Left/physiology , Aged , Atrioventricular Node/diagnostic imaging , Cardiac Volume/physiology , Diastole , Echocardiography , Echocardiography, Doppler , Exercise Test , Female , Heart Block/complications , Heart Block/diagnostic imaging , Heart Block/therapy , Humans , Hypertrophy, Left Ventricular/complications , Male , Middle Aged , Myocardial Contraction/physiology , Rest/physiologyABSTRACT
Palpitations are a symptom often reported by patients with apical hypertrophic cardiomyopathy (HCM), yet the arrhythmias associated with this type of HCM have not been studied adequately. Herein, a case of persistently recurrent atrial flutter in a 63-year-old Greek man with apical HCM is presented. Synchronized direct-current shocks were used twice during his hospitalization in order to convert atrial flutter to sinus rhythm. No definite precipitating factor for the induction of atrial flutter was identified.
