NONINVASIVE BEAT-TO-BEAT ARTERIAL BLOOD-PRESSURE MEASUREMENT DURING VVI AND DDD PACING - RELATIONSHIP TO SYMPTOMATIC BENEFIT FROM DDD PACING

To noninvasively assess the hemodynamic effects of VVI and DDD pacing modes we measured beat-to-beat arterial blood pressure during VVI and DDD pacing in 30 patients with complete heart block (CHB), using finge rtip photoplethysmography. Of these patients, 15 undertook a double-bl ind cross-over comparison of the symptomatic effects of VVI versus DDD pacing to determine the relationship between blood pressure changes a nd the occurrence of symptoms suggestive of the pacemaker syndrome dur ing ventricular pacing. Mean (SD) systolic blood pressure was 11.7 (15 .4) mmHg lower during VVI pacing compared to DDD pacing (P < 0.0005). The mean (SD) beat-to-beat variability of systolic blood pressure was 5.20 (2.87%) in VVI mode versus 2.12 (1.07%) in DDD mode (P < 0.000000 5). In comparison with DDD pacing, the excess of symptoms experienced by patients during VVI pacing did not correlate with the change in mea n systolic blood pressure, but was significantly correlated with the i ncrease in beat-to-beat systolic blood pressure variation during VVI p acing (r = 0.58, p = 0.024). We conclude that noninvasive measurement of fingertip arterial beat-to-beat blood pressure is a rapid and simpl e method of assessing the hemodynamic effect of VVI pacing. Beat-to-be at blood pressure variability was related to symptomatic intolerance o f VVI pacing and may have potential utility as an aid to diagnosis or as a predictor of pacemaker syndrome.