Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function

Schmidt, Christoph; Frielingsdorf, Jürgen; Debrunner, Marianne; Tavakoli, Reza; Genoni, Michele; Straumann, Edwin; Bertel, Osmund; Naegeli, Barbara

doi:10.1093/europace/eum042

Cited by 23 publications

(13 citation statements)

References 42 publications

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“…A number of small single‐center studies have compared Bi‐V pacing to other pacing modalities in the immediate postoperative period following valve surgery, CABG or a combination of both, with mixed results . Given the conflicting data, a recent randomized controlled study by Spotnitz et al .…”

Section: Discussionmentioning

confidence: 99%

“…A number of small single-center studies have compared Bi-V pacing to other pacing modalities in the immediate postoperative period following valve surgery, CABG or a combination of both, with mixed results. [17][18][19][20][21][22][23][24][25] Given the conflicting data, a recent randomized controlled study by Spotnitz et al 26 sought to determine if a 3 phase optimization of Bi-V pacing soon after cardiac surgery improved cardiac index (CI). The study revealed no significant improvement in CI, but patients with AV surgery had a 29% increase in CI from Bi-V pacing compared to the control group (P = 0.01).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?

Bose

Upadhyay

Kandala

et al. 2014

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?

Bose

Upadhyay

Kandala

et al. 2014

Cardiovasc electrophysiol

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“…Tanaka et al and others [18,22,23] observed greatest benefits in patients with low EF and wide QRS complex. Whereas others, report no significant hemodynamic improvement with these pacing modes or even no adverse effects with RA-RVP in populations with normal ventricular function [19-21]. …”

Section: Discussionmentioning

confidence: 99%

“…The optimum VVD differed from the nominal value, in 5% CO improvement. Overall, optimized BiVP resulted in a CO increase of 10% versus SR. Schmidt and co-workers [19],pointed out the limitation of not using AVD and VVD optimization with BiVP, after not obtaining any HD improvement in CBPG cases.…”

Section: Discussionmentioning

confidence: 99%

Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

García-Bengochea

Teijeira-Fernández

Calvelo

et al. 2012

J Cardiothorac Surg

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BackgroundTo evaluate, with different pacing modes, acute changes in left ventricular systolic function, obtained by continuous cardiac output thermodilution in various subsets of patients undergoing cardiopulmonary bypass surgery. Increments of mean arterial pressure and cardiac output were considered the end point.MethodsFifty cases electively submitted to cardiac surgery were analyzed. Isolated valve surgery 62%, coronary revascularization 30% and 8% mixed disease. Left ventricular ejection fraction was preserved in 50%,36% had moderate depression,(EF 36%-50%) whereas 14% had severe depression (EF < 35%). Left bundle branch block occurred in 18%. Preoperatively 84% were in sinus rhythm and 16% in atrial fibrillation. The different subgroups were analyzed for comparisons. Right atrial-right ventricular and right atrial-left ventricular pacing were employed in sinus rhytm. Biventricular pacing was also used in atrial fibrillation.ResultsRight atrium-right ventricular pacing, decreased significantly mean arterial pressure and cardiac output (2.3%) in the overall population and in the subgroups studied. Right atrium-left ventricle, increased mean arterial pressure and cardiac output in 79% of patients and yielded cardiac output increments of 7.5% (0.40 l/m) in the low ejection fraction subgroup and 7.3% (0.43 l/m) in the left bundle branch block subset. In atrial fibrillation patients, left ventricular and biventricular pacing produced a significant increase in cardiac output 8.5% (0.39 l/min) and 11.6% (0.53 l/min) respectively. The dP/dt max increased significantly with both modes (p = 0.021,p = 0.028).ConclusionRight atrial-right ventricular pacing generated adverse hemodynamic effects. Right atrium-left ventricular pacing produced significant CO improvement particularly in cases with depressed ventricular function and left bundle branch block. The greatest increments were observed with left ventricular or biventricular pacing in atrial fibrillation with depressed ejection fraction.

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“…This is achieved by attaching temporary pacing wires to the right atrium (RA), right ventricle (RV) and LV before closing the sternum. Previous studies of permanent BiV pacing have reported acute improvements in haemodynamic function [1–4] but attempts to reproduce these findings acutely after cardiac surgery have produced mixed results [5–10]. In addition, one postoperative study has reported no improvement in coronary conduit flow with BiV pacing compared with atrial synchronous RV pacing [11].…”

Section: Introductionmentioning

confidence: 99%

Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

Russell

Tan

O’Keefe

et al. 2012

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESOptimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care.METHODSThirty-eight patients in sinus rhythm, ejection fraction ≤35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes.RESULTSThe duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005).CONCLUSIONSPostoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery.

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Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function

Cited by 23 publications

References 42 publications

Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?

Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?

Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

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