[Physiologic effect of short AV intervals on LV filling time in VDD pacemakers--mitral valve closure in relation to atrial and ventricular contraction].

The effect of mitral valve closure on LV filling time and the onset of LV systole were assessed in 21 normals, 11 patients with left bundle branch block and in 19 patients with VDD pacemakers, which were programmed for the AV intervals 50, 150 and 250 ms, by means of echo-apexcardiography. Mitral valve closure was significantly delayed with increasing delay of intraventricular conduction: 52 +/- 11 ms in normals, 65 +/- 20 ms in LBBB patients and 127 +/- 14 ms in VDD patients. There was a similar distribution of the apexcardiographic upstroke and aortic valve opening in the 3 groups. With increasing AV intervals mitral valve closure was earlier: 127 +/- 14 ms at AV = 50 ms, 83 +/- 38 ms at AV = 150 ms and 20 +/- 75 ms at AV = 250 ms whereas the onset of LV systole and mitral valve opening remained unaltered. Thus filling time expressed in percent of cycle length was reduced from 50 +/- 6% at AV = 50 ms to 45 +/- 9% and to 38 +/- 10% at AV = 250 ms (p less than 0.001). The late onset of LV systole in VDD pacemaker patients therefore reduces LV filling time unless this is compensated by programming a short AV interval in order to maintain the physiological interval between atrial and ventricular contraction.