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

Journal of Cardiothoracic Surgery

José R González Juanatey¹  Francisco Gude²  Julian Alvarez Escudero³  Daniel Sánchez Calvelo⁴  Angel L Fernández⁴  Jose B García-Bengochea⁴ 

[1] Department of Cardiology, Hospital Clínico Universitario, 15706, Santiago de Compostela, Spain;Epidemiological Clinic, Santiago de Compostela, Spain;Department of Anesthesiology, Santiago de Compostela, Spain;Cardiac Surgical Division. Department of Surgery, Hospital Clínico Universitario, 15706, Santiago de Compostela, Spain

关键词: Atrial fibrillation;    Cardiac output optimization;    Biventricular;    Left ventricular;    Postoperative cardiac pacing;   

Others  :  1152658
DOI  :  10.1186/1749-8090-7-113

 received in 2012-06-10, accepted in 2012-09-17,  发布年份 2012

【 摘 要 】

Background

To 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.

Methods

Fifty 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.

Results

Right 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).

Conclusion

Right 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.

【 授权许可】

   
2012 García Bengochea et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344:873-880.
• [2]Auricchio A, Stellbrink C, Sack S, Block M, Vogt J¨ u, Bakker P: Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002, 39:2026-2033.
• [3]Linde C, Leclercq C, Rex C, Garnigue S, Lavergne T, Cazeau S, et al.: Long-term benefits of biventricular pacing in congestive heart failure: results from the multisite stimulation in cardiomyopathy (mustic) study. J Am Coll Cardiol 2002, 40(1):111-118.
• [4]Tse HF, Yu C, Wong KK, Tsang V, Leung YL, Ho WY, et al.: Functional abnormalities in patients with permanent right ventricular pacing. the effect of sites of electrical stimulation. J Am Coll Cardiol 2002, 40:1451-1458.
• [5]Bolli R: Mechanisms of myocardial “stunning”. Circulation 1990, 82:723.38.
• [6]Reynolds HR, Tunick PA, Grossi EA, Dilmanian H, Colvin SB, Kronzon I: Paradoxical septal motion after cardiac surgery: a review of 3292 cases. Clin Cardiol 2007, 30:621-623.
• [7]Manolis AS: The deleterious consequences of right ventricular apical pacing: time to seek alternarte site pacing. Pacing Clin Electrophysiol 2006, 29(3):298-315.
• [8]Cannesson M, Farhat F, Scarlata M, Cassar E, Lehot JJ: The impact of atrio-biventricular pacing on hemodynamics and left ventricular dyssynchrony compared with atrio-right ventricular pacing alone in the postoperative period of cardiac surgery. J Cardiothorac Vasc Anesth 2009, 23:306-311.
• [9]Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, et al.: Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000, 102:3053-3059.
• [10]Bakhtiary F, Dogan S, Dzemali O, Ackerman H, Kleine P, Schachinger V, et al.: Impact of different pacing modes on left ventricular contractility following cardio pulmonary bypass. Pacing Clin Electrophysiol 2007, 30(9):1083-1090.
• [11]Wang DY, Richmond ME, Quinn A, Mirani AJ, Rusanov A, Yamalanchi V, et al.: Optimized temporary biventricular pacing acutely improves intraoperative cardiac output after weaning from cardiopulmonary bypass: a substudy of a randomized clinical trial. J Thorac Cardiovasc Surg 2011, 141:1002-1008.
• [12]Quinn TA, Cabreriza SE, Richmond ME, Weinberg AD, Holms JW, Spotnitz HM: Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist. Am J Physiol Heart Circ Physiol 2009, 297:H2220-H2226.
• [13]Hanke T, Misfeld M, Heringlake M, Schreuder JJ, Wiegand UKH, Eberhardt F: The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function. a pressure-volume loop analysis. J Thorac Cardiovasc Surg 2009, 138:148-156.
• [14]Spotnitz ME, Wang DY, Quinn TA, Richmond ME, Rusanov A, Johnston T, et al.: J Cardiothorac Vasc Anesth. 2011, 25:238-242.
• [15]García-Bengochea JB, Vega M, Fernández A, Rubio J, Sánchez D, Amaro A, et al.: Alternativas técnicas de resincronización ventricular epicárdica en la insuficiencia cardiaca. Cir Cardiov 2003, 10:37-44.
• [16]Flynn MJ, McComb JM, Dark JH: Temporary left ventricular pacing improves hemodynamic performance in patients requiring epicardial pacing post cardiac surgery. Eur J Cardiothorac Surg 2005, 28:250-253.
• [17]Eberhardt F, Heringlake M, Massalme MS, Dyllus A, Misfeld M, Sievers HH, et al.: The effect of biventricular pacing after coronary artery bypass grafting: A prospective randomized trial of different pacing modes in patients with reduced left ventricular function. J Thorac Cardiovasc Surg 2009, 137:1461-1467.
• [18]Weisse U, Isgro F, Werling C, Lehmann A, Saggau W: Impact of atrio-biventricular pacing to poor left ventricular function after CABG. Thorac Cardiovasc Surg 2002, 50:131-135.
• [19]Schmidt C, Frielingsdorf J, Debrunner M, Tabacoli R, Genoni M, Straumann E, et al.: Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function. Europace 2007, 9:432-436.
• [20]Evonich RF, Stephens JC, Mehri W, Dukkipati S, Tepe N, Shannon F, et al.: The role of temporary biventricular pacing in the cardiac surgical patient with severely reduced left ventricular systolic function. J Thorac Cardiovasc Surg 2008, 136:915-921.
• [21]Healy DG, Hargrove M, Doddakulla K, Hinchion J, O′Donnell A, Aherne T: Impact of patient modality and biventricular pacing on cardiac output and coronary coronary flow in the post-cardiothomy patient. Interact Cardiovasc Thorac Surg 2008, 7:805-808.
• [22]Vaughan P, Vhatti F, Hunter S, Dunning J: Does biventricular pacing provide a superior cardiac output compared to univentricular pacing wires after cardiac surgery? Interact Cardiovasc Thorac Surg 2009, 8:673-678.
• [23]Dzemali O, Bakhtiary F, Israel CW, Ackermann H, Mortiz A, Keline P: Impact of different pacing modes on left ventricular function following cardiopulmonary bypass. Thorac Cardiovasc Surg 2008, 56:87-92.
• [24]Blanc JJ, Etienne Y, Gillard M, Mansourati J, Munier S, Boschat J, et al.: Evaluation of different ventricular pacing sites in patients with severe heart failure: Results of an acute hemodynamic study. Circulation 1997, 96:3273-3277.
• [25]Fernández AL, García-Bengochea JB, Sánchez D, Alvarez J: Temporary left ventricular pacing after cardiac surgery. Eur J Cardiothorac Surg 2006, 29:633-634.