Hemodynamics of Cardiac Pacing: Optimization and Programming to Enhance Cardiac Function

Faisal F. Syed, David L. Hayes, Paul A. Friedman, Samuel J. Asirvatham

Research output: Chapter in Book/Report/Conference proceedingChapter


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 languageEnglish (US)
Title of host publicationCardiac Pacing, Defibrillation and Resynchronization
Subtitle of host publicationA Clinical Approach
Number of pages52
ISBN (Print)9780470658338
StatePublished - Dec 17 2012


  • AV (atrioventricular) optimization
  • Cardiac resynchronization therapy
  • Dyssynchrony
  • Hemodynamics
  • Left atrial pacing
  • Pacemaker syndrome
  • Pacing mode
  • V-V optimization

ASJC Scopus subject areas

  • Medicine(all)


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