Adaptation of the left ventricle to sudden changes in heart rate in patients with artificial pacemakers

Abstract
In five patients treated with external pacemaker for complete heart block, the adaptation of left ventricular volume to sudden changes in ventricular rate has been analysed on a beat-to-beat basis, by one-plane cineangiocardiography and simultaneous aortic pressure recordings. The results are unambiguous and show: (1) When heart rate is changed above a certain lower limit left ventricular stroke volume varies inversely with heart rate. (2) The changes in stroke volume are brought about by changes in left ventricular end-diastolic volume proportionate to the duration of mechanical diastole and filling energy. The end-systolic volume is unchanged. (3) Left ventricular end-diastolic volume and stroke volume adapt, on a beat-to-beat basis, to changes in heart rate. (4) There is a lower border-frequency at which the ventricular end-diastolic volume is maximal. Below this frequency, a further increase in length of diastole does not increase the stroke volume.