Effects of variation of atrioventricular interval on left ventricular diastolic filling dynamics and atrial natriuretic peptide levels in patients with DDD pacing for complete heart block

Europace. 2005 Nov;7(6):576-83. doi: 10.1016/j.eupc.2005.03.012. Epub 2005 Jul 18.


Aims: This study was designed to evaluate the effect of variation of atrioventricular (AV) interval (AVI) on left ventricular (LV) diastolic function and ANP and c-GMP levels during DDD pacing in patients with complete AV block and normal systolic function.

Methods: The study population comprised 22 patients (mean age 65.2+/-14.3, 12 males) with complete AV block. All patients underwent complete Doppler echocardiography before implantation of a DDD-pacemaker. Twenty-four hours later, patients were paced for a period of 30 min, at three different AVIs (100 ms, 150 ms and 200 ms), at rest. During each pacing period, Doppler-derived LV diastolic indices were re-evaluated and ANP and c-GMP levels were reassessed.

Results: Overall comparison showed a significant progressive augmentation, from 200 ms to 100 ms AVI, in transmitral E/A wave ratio (from 0.53+/-0.13 to 0.90+/-0.25, P = 0.0005) and in LV filling time (from 0.33+/-0.05 to 0.40+/-0.06s, P = 0.0005), followed by a significant progressive reduction in ANP and c-GMP levels. An AVI of 100 ms or 150 ms was associated with improved diastolic indices and lower natriuretic peptides levels, compared with the longer AVI.

Conclusion: Programmed AVI during DDD pacing affects LV diastolic performance and plasma ANP and c-GMP levels. The assessment of these parameters constitutes a useful modality for AVI optimization.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atrial Natriuretic Factor / blood*
  • Atrioventricular Node / physiopathology*
  • Cardiac Pacing, Artificial* / methods
  • Cyclic GMP / blood
  • Diastole
  • Echocardiography
  • Echocardiography, Doppler
  • Female
  • Heart Block / blood
  • Heart Block / diagnostic imaging
  • Heart Block / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial
  • Ventricular Function, Left*


  • Atrial Natriuretic Factor
  • Cyclic GMP