| Temporary epicardial ventricular stimulation in patients with atrial fibrillation: acute effects of ventricular pacing site on bypass graft flows. | |
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MedLine Citation:
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PMID: 19583610 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Data on coronary artery bypass grafts flows in patients with atrial fibrillation (AF) requiring epicardial ventricular pacing is lacking. This study aimed to evaluate the optimal epicardial ventricular pacing site in patients with AF following coronary artery bypass surgery (CABG). METHODS: In 23 consecutive patients (mean age = 69.2 +/- 1.9 years, gender = 62% male, ejection fraction [EF]= 50.4 +/- 2.1%) monoventricular stimulations (VVI) were tested with a constant pacing rate of 100 bpm. The impact of ventricular pacing on bypass graft flow (transit-time flow probe) and pulsatility index (PI) were measured after lead placement on the mid paraseptal region of the right (RVPS) and the left (LVPS) ventricle, on the right inferior wall (RVIW), and on the right ventricular outflow tract (RVOT). In addition, hemodynamic parameters were measured. Patients served as their own control. RESULTS: Comparison of all tested pacing locations revealed that RVOT stimulation provided the highest bypass grafts flows (59.9 +/- 6.1 mL/min) and PI (2.2 +/- 0.1) when compared with RVPS (51.3 +/- 4.7 mL/min, PI = 2.6 +/- 0.2), RVIW (54.0 +/- 5.1 mL/m; PI = 2.4 +/- 0.2), and LVPS (53.1 +/- 4.5 mL/min; PI = 2.3 +/- 0.1), respectively (p < 0.05). When analyzing patients according to their preoperative LV function (group I = EF > 50%; group II = EF < 50%), higher bypass graft flows were observed with RVOT pacing in patients with lower EF (p = n.s.). CONCLUSIONS: Temporary RVOT pacing facilitates optimal bypass graft flows when compared with other ventricular pacing sites and should be the preferred method of temporary pacing in cardiac surgery patients with AF. Especially in patients with low EF following CABG, RVOT pacing may improve myocardial oxygen conditions for the ischemic myocardium and enhance graft patency in the early postoperative period. |
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Authors:
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Navid Madershahian; Oliver J Liakopoulos; Thorsten Wittwer; Jens Wippermann; Ferdinand Kuhn-Regnier; Hamid Naraghi; Thorsten Wahlers |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiac surgery Volume: 24 ISSN: 1540-8191 ISO Abbreviation: J Card Surg Publication Date: 2009 Jul-Aug |
Date Detail:
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Created Date: 2009-07-08 Completed Date: 2009-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8908809 Medline TA: J Card Surg Country: United States |
Other Details:
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Languages: eng Pagination: 424-8 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Surgery, Cologne University Heart Centre, Kerpener Strasse 62, Cologne, Germany. navid.madershahian@web.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Atrial Fibrillation / therapy* Cardiac Pacing, Artificial / methods* Coronary Artery Bypass* Coronary Circulation* Female Humans Male Prospective Studies Pulsatile Flow Stroke Volume Ventricular Function |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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