Orthostatic responses in patients with DDD pacemakers: Signs of autonomic dysfunction

I. Ovsyshcher, J. N. Gross, S. Blumberg, S. Furman

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Responses to orthostasis may be altered in states associated with autonomic dysfunction. Computerized impedance cardiography, a noninvasive method for continuous assessment of stroke volume and mean blood pressure, was utilized to study the postural hemodynamic changes in eight normal and 27 patients with DDD pacemakers. Twenty patients with complete heart block (five with heart failure) were studied in the VDD mode and seven patients with sick sinus syndrome were assessed in DVI (four) or VDD (three). The results with pacemaker patients are significantly different from those observed in normal. Pacemaker patient responses to standing included: (1) a reduction in systolic, diastolic, and mean blood pressure; (2) an increase in heart rate in patients with intact sinus node function and no change in patients with sick sinus syndrome; and (3) stroke volume was unchanged in patients with sick sinus syndrome or heart failure and only modest reduction occurred in the remaining patients. Conclusions: (1) No reduction in stroke volume during upright posture occurs in DDD patients with sick sinus syndrome and this appears to be a compensatory reaction to an inadequate heart rate response to standing; (2) The hemodynamic response of DDD patients to the assumption of an upright posture is consistent with autonomic dysfunction; and (3) The primary cause for autonomic dysfunction in DDD patients may be the asynchronous ventricular depolarization caused by right ventricular pacing.

Original languageEnglish (US)
Pages (from-to)1932-1936
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Issue number11 II
StatePublished - 1992
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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