Document Detail


Optimized temporary biventricular pacing acutely improves intraoperative cardiac output after weaning from cardiopulmonary bypass: a substudy of a randomized clinical trial.
MedLine Citation:
PMID:  20800242     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Permanent biventricular pacing benefits patients with heart failure and interventricular conduction delay, but the importance of pacing with and without optimization in patients at risk of low cardiac output after cardiac surgery is unknown. We hypothesized that pacing parameters independently affect cardiac output. Accordingly, we analyzed aortic flow measured with an electromagnetic flowmeter in patients at risk of low cardiac output during an ongoing randomized clinical trial of biventricular pacing (n = 11) versus standard of care (n = 9).
METHODS: A substudy was conducted in all 20 patients in both groups with stable pacing after coronary artery bypass grafting, valve surgery, or both. Ejection fraction averaged 33% ± 15%, and QRS duration was 116 ± 19 ms. Effects were measured within 1 hour of the conclusion of cardiopulmonary bypass. Atrioventricular delay (7 settings) and interventricular delay (9 settings) were optimized in random sequence.
RESULTS: Optimization of atrioventricular delay (171 ± 8 ms) at an interventricular delay of 0 ms increased flow by 14% versus the worst setting (111 ± 11 ms, P < .001) and 7% versus nominal atrioventricular delay (120 ms, P < .001). Interventricular delay optimization increased flow 10% versus the worst setting (P < .001) and 5% versus nominal interventricular delay (0 ms, P < .001). Optimized pacing increased cardiac output 13% versus atrial pacing at matched heart rate (5.5 ± 0.5 vs 4.9 ± 0.6 L/min, P = .003) and 10% versus sinus rhythm (5.0 ± 0.6 L/min, P = .019).
CONCLUSIONS: Temporary biventricular pacing increases intraoperative cardiac output in patients with left ventricular dysfunction undergoing cardiac surgery. Atrioventricular and interventricular delay optimization maximizes this benefit.
Authors:
Daniel Y Wang; Marc E Richmond; T Alexander Quinn; Ajay J Mirani; Alexander Rusanov; Vinay Yalamanchi; Alan D Weinberg; Santos E Cabreriza; Henry M Spotnitz
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2010-08-30
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-22     Completed Date:  2011-05-16     Revised Date:  2014-11-07    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1002-8, 1008.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aorta / physiopathology
Cardiac Output*
Cardiac Output, Low / etiology,  physiopathology,  prevention & control*
Cardiac Resynchronization Therapy / methods*
Cardiac Surgical Procedures / adverse effects*
Cardiopulmonary Bypass / adverse effects*
Coronary Artery Bypass / adverse effects
Electrocardiography
Heart Rate
Heart Valves / surgery
Humans
Intraoperative Care
New York City
Regional Blood Flow
Rheology
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left / physiopathology,  surgery*
Grant Support
ID/Acronym/Agency:
R01 HL080152/HL/NHLBI NIH HHS; R01 HL080152/HL/NHLBI NIH HHS; R01 HL080152-01A2/HL/NHLBI NIH HHS; R01 HL080152-02/HL/NHLBI NIH HHS; R01 HL080152-03/HL/NHLBI NIH HHS; R01 HL080152-03S1/HL/NHLBI NIH HHS; R01 HL080152-04/HL/NHLBI NIH HHS; T32 HL007854/HL/NHLBI NIH HHS
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