Radionuclide evaluation of postextrasystolic potentiation of left ventricular function induced by atrial and ventricular stimulation

Abstract

Postextrasystolic potentiation of left ventricular function induced by ventricular and atrial stimulation was compared in 10 patients using radionuclide ventriculography. After insertion of pacing wires, a preliminary radionuclide ventriculogram was obtained and then ventricular and atrial trigeminy was induced in random order, each with identical R-R coupling intervals, each for 6 to 10 minutes. During the stimulation studies, radionuclide data were acquired in electrocardiographic gated list mode format. Left ventricular ejection fraction and relative end-diastolic and end-systolic volume changes were measured for each reformatted composite sinus, atrial and ventricular premature beat and potentiated beat. The volume changes were normalized to the count-based values obtained for the sinus beat of the appropriate study. Postextrasystolic potentiation induced by either ventricular or atrial stimulation was characterized by similar significant increases in left ventricular ejection fraction (mean +/- standard deviation 7 +/- 3 percent, p < 0.01 versus 7 +/- 5 percent, p < 0.01; difference not significant [NS]) and decreases in relative end-systolic volume (-12 +/- 12 percent, p < 0.01 versus -12 +/- 8 percent, p < 0.01; NS) but little change in relative end-diastolic volume (+5 +/- 10 percent, NS versus +4 +/- 7 percent, NS; NS). This was despite a longer compensatory pause (1,120 +/- 220 versus 1,050 +/- 190 ms, p < 0.01) after the ventricular premature beat. It is concluded that there is no difference in the postextrasystolic potentiation induced by atrial or ventricular premature stimulation.