**Author details**

Joe Xie1 , Larry D. Dial2 and Joseph I. Shapiro2\*

\*Address all correspondence to: shapiroj@marshall.edu


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**Chapter 6**

**Dobutamine-Induced Mechanical Alternans**

Mechanical alternans (MA) is a mysterious phenomenon. MA, a condition characterized by beat-to-beat oscillation in the strength of cardiac muscle contraction at a constant heart rate, has been observed in patients with severe heart failure and in animal models of this condition. Although MA is rare under resting conditions in individuals with controlled heart failure, at higher heart rates it is more prevalent and likely to be sustained, as exemplified by pacinginduced MA or dobutamine-induced MA. However, few studies have addressed the clinical implications of dobutamine-induced MA in patients with heart failure. We therefore prospec‐ tively examined and compared the prognostic value of dobutamine- and pacing- induced MA in ambulatory patients with idiopathic dilated myocardiopathy (IDCM) in sinus rhythm.[1] Furthermore, this review addresses the clinical circumstances, relevance of MA, current

Phenomenon of alternating weak and strong beats observed in a heart which is contracting with constant intervals between beats. It has a long history. Experimental descriptions first appeared over a century ago, and since then there has been a sustained debate among clinicians and physiologists about its origins and clinical significance. A clinical description of an alternating pulse by Traube is often quoted as appearing earlier. [2] However, careful inspec‐ tion of his figure shows alternating interbeat intervals. In fact, Traube himself commented on the alternation of intervals and used the term "bigeminus" in the title of his report, although the true nature of this arrhythmia can only be guessed at since the electrocardiograms had yet

and reproduction in any medium, provided the original work is properly cited.

© 2013 Hirashiki and Murohara; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

understanding with ideas about its mechanism, and some future perspectives.

Akihiro Hirashiki and Toyoaki Murohara

http://dx.doi.org/10.5772/55003

**2. Mechanical Alternans (MA)**

**2.1. History of MA**

**1. Introduction**

Additional information is available at the end of the chapter
