Is atrial activation beneficial in heart transplant recipients?

• Published in: Journal of the American College of Cardiology 1990-11, Vol.16 (5), p.1201-1204
• Main Authors: Midei, Mark G., Baughman, Kenneth L., Achuff, Stephen C., Walford, Gary D., Baumgartner, William, Brinker, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Atrial Function - physiology; Biological and medical sciences; Blood Pressure - physiology; Cardiac Output - physiology; Cardiac Pacing, Artificial - methods; Electrocardiography; Female; Heart Transplantation - physiology; Humans; Male; Medical sciences; Middle Aged; Pacemaker, Artificial; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Function - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(90)90553-2

Because of the distortion of alrial morphology that occurs during cardiac allograft transplantation in humans, the beneficial effects of properly sequenced atrial and ventricular activation are unclear in these patients. To evaluate the atrial contribution to ventricular pump performance in heart transplant recipients, arterial pressure and cardiac output during pacing from either chamber were measured in nine patients 10 ± 1 days after transplantation. Systolic, diastolic and mean systemic arterial pressures were significantly higher during atrial pacing compared with ventricular pacing: 143 ± 23 versus 125 ± 20 mm Hg, 73 ± 15 versus 66 ± 14 mm Hg and 94 ± 17 versus 84 ± 16 mm Hg, respectively (p < 0.05 for all). In addition, cardiac output decreased from 5.5 ± 1.4 to 4.6 ± 1.5 liters/min (p < 0.005) for atrial versus ventricular pacing. Thus, there is a significant atrial contribution to cardiac performance in patients after heart transplantation. This may have clinical implications in those patients who later require a permanent pacemaker.