Reversibility of hypotension and shock by atrial or atrioventricular sequential pacing in patients with right ventricular infarction

John C. Love, Charles I. Haffajee, Joel M. Gore, Joseph S. Alpert

Research output: Contribution to journalArticle

61 Scopus citations

Abstract

Hypotension and shock associated with heart block and other forms of atrioventricular (AV) dissociation frequently accompany right ventricular infarction (RVI). Such patients do not invariably improve with ventricular pacing. We evaluated the relative effects of AV dissociated rhythms (ventricular pacing or nodal rhythm) and AV synchronous rhythms (atrial pacing, AV sequential pacing, or return to normal sinus rhythm) in seven patients with RVI complicated by AV dissociation, who had hypotension or shock. Hemodynamic monitoring demonstrated the characteristic features of RVI in all patients. Restoration of AV synchrony resulted in a highly significant (p ≤ 0.001) increase in systolic blood pressure (88.0 ± 16.5 mm Hg to 133.0 ± 21.8 mm Hg), cardiac output (3.8 ± 0.9 L/min to 5.7 ± 0.9 L/min), and stroke volume (40.5 ± 6.9 cc to 61.0 ± 10.0 cc). We conclude that restoration of normal AV synchrony has a marked effect on stroke volume in this setting and that atrial or AV pacing can reverse hypotension and shock in RVI complicated by AV dissociation.

Original languageEnglish (US)
Pages (from-to)5-13
Number of pages9
JournalAmerican Heart Journal
Volume108
Issue number1
DOIs
StatePublished - Jul 1984
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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