Noninvasive Beat-to-Beat Arterial Blood Pressure Measurement During VVI and DDD Pacing: Relationship to Symptomatic Benefit from DDD Pacing K.M. CHANNON, M.R. HARCREAVES, M. GARDNER, and O.J.M. ORMEROD From the Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom CHANNON, K.M., ET AL.; 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 beot-to-beat arterial blood pressure during VVI and DDD pacing in 30 patients with complete heart block (CHB), using fingertip photo- pleihysmography. Of these patients, 15 undertook a double-blind cross-over comparison of tbe symp- tomatic effects of VVI versus DDD pacing to determine the relationsbip between blood pressure changes atui tbe occurrence of symptoms suggestive of tbe pacemaker syndrome during ventricular pacing. Mean (SD) systolic blood pressure was 11.7 (15.4) mmHg lower during WI pacing compared to DDD pacing (P < 0.0005). Tbe 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 < 0.0000005). In comparison witb DDD pacing, the excess of symp- toms experienced by patients during WI pacing did not correlate witb tbe cbange in mean systolic blood pressure, but was significantly correlated witb the increase in beatto-beat systolic blood pressure varia- tion during VVI pacing (r = 0.58, P = 0.024). We conclude that noninvasive measurement of fingertip ar- terial beat-tO'beat blood pressure is a rapid and simple metbod of assessing tbe bemodynamic effect of VVI pacing. Beat-to-beat blood pressure variability was related to symptomatic intolerance of VVI pacing and may bave potential utility as an aid to diagnosis or as a predictor of pacemaker syndrome. (PACE 1997:20lPt. I]:25-33) blood pressure, beat-to-beat variation, ventricular demand pacing, pacemaker syndrome, finapres Inlroduction Dual chamber (DDD) pacing is considered su- perior to single chamher ventricular demand (VVI) pacing for the treatment of both atrioventricular (AV) hlock and sinoatrial disease.^"•' The benefits of physiological pacing arise from restoration of M.H. is a British Heart Foundation Junior Research Fellow. The support of APC (.'artJiovasriilar is gratefully auknowl- tjdged. This work was presented in part at (he 15th Annual Sci- entific Sessions of the North American Society of Facing and iilectrophysiology, 1994. Address for reprints: Dr. Koith M. Channon, Cardiovascular Di- vi.sion, Box 3060, Duke Universily Medical Center, Durham, NC; 27710. Fax: (919) 684-8591. Received May 1, 1995: revision September 8, 1995; accepted September 27, 1995. AV synchrony, and from rate-responsiveness due to P wave tracking. When compared with VVI pac- ing, it is seen that DDD pacing improves symp- toms, maximal exercise tolerance, hemodynamic variahles, and results in a reduction in the inci- dence of the pacemaker syndrome.**"" Although there is an undoubted overall henefit from DDD pacing, some patients tolerate VVI pacing without any adverse symptoms.^ ^'• '• • ^• ^ " Since VVI pace- makers are less costly and complex, they continue to be used in place of DDD pacing in a significant nnmber of patients, notably in the elderly.^^'^^ Thus, clinically applicable methods of identify- ing patients likely to be intolerant of VVI pacing would be useful aids to pacemaker pre- scription and would reduce the incidence of PACE, Vol. 20 January 1997, Part I 25