Hemodynamic and Symptomatic Consequences of Ventricular Pacing

Rick A. Nishimura, Bernard J. Gersh, Ronald E. Vlietstra, Michael J. Osborn, Duane M. Ilstrup, David R. Holmes

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


NISHIMURA, R.A. et al.: Hemodynamic and symptomatic consequences of ventricular pacing. After implantation of a ventricular demand pacemaker (VVI), occasional patients continue to have dizziness, syncope, or near syncope (“pacemaker syndrome”). To identify patients in whom VVI pacing may have deleterious effects, we compared cuff blood pressure responses to VVI pacing with blood pressure responses to atrioventricsler sequential pacing (DVI) or sinus rhythm in 50 consecutive patients. Patients with intact ventriculoatrial conduction had a much greater decrease in systolic blood pressure with VVI pacing (24 ± 11 mm Hg) than those with ventriculoatrial dissociation (−4 ± 15 mm Hg) (P<0.005). Patients who were in heart failure had a lesser decrease in blood pressure with VVI pacing than did those without failure (P<0.05); 13 of the 14 heart failure patients lacked ventriculoatrial conduction. Ten patients had symptomatic dizziness after VVI pacing; the incidence of symptoms was higher in patients with ventriculoatrial conduction (9 of 23) than in those without ventriculoatrial conduction (1 of 27) (P<0.003). We conclude that the presence of intact ventriculoatrial conduction appears to be a crucial determinent of the hemodynamic response to VVI pacing, and its presence may identify patients who are at risk for “pacemaker syndrome.”

Original languageEnglish (US)
Pages (from-to)903-910
Number of pages8
JournalPacing and Clinical Electrophysiology
Issue number6
StatePublished - Nov 1982


  • atrioventricular synchrony
  • dual‐chamber pacing
  • pacemaker syndrome
  • permanent pacing
  • ventriculer demand pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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