Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function

Isabella Tan, Hosen Kiat, Edward Barin, Mark Butlin*, Alberto P. Avolio

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78=10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED (P<0.01), central aortic pulse pressure (P<0.01), augmentation pressure (P 0.0001), and magnitudes of both forward and reflected waves (P<0.05 and P<0.003, respectively), but not cfPWV (P<0.57) or AIx (P<0.38). However, at a fixed HR, significant differences in pulse pressure amplification (P 0.001), AIx (P 0.0001), RM (P<0.03), and RI (P<0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.

Original languageEnglish
Pages (from-to)771-780
Number of pages10
JournalJournal of Applied Physiology
Issue number3
Publication statusPublished - 1 Sept 2016


  • Arterial stiffness
  • Heart rate
  • Pacing
  • Pulse wave analysis
  • Pulse wave velocity
  • Wave reflection


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