Abstract
Background: Patients with severely impaired left ventricular (LV) function often demonstrate prolonged inter- and intraventricular conduction. This prospective study investigates hemodynamic effects and outcomes of perioperative temporary biventricular pacing in patients with heart failure undergoing heart surgery. Methods: 80 consecutive cardiac surgery patients with a LV ejection fraction below 35 % received biventricular stimulation via temporary myocardial electrodes. Group 1 consisted of 40 patients with LV dilatation (mean LVEDD 65 ± 5 mm), Group 2 of 40 patients with normal or slightly dilated LV (mean LVEDD 52 ± 4 mm). Results: Hemodynamic parameters were measured immediately, 6 and 24 hours after operation. An increase of cardiac index (CI) and arterial blood pressure with biventricular pacing was observed in 27 patients (Group 1/67.5 %) versus 22 patients (Group 2/55 %) from 2.4 ± 0.7 l/min/m2 to 3.5 ± 0.5 l/min/m2 (p < 0.01). This benefit persisted 6 and 24 hours postoperatively. The remaining patients already showed a higher cardiac index prior to pacing (3.7 ± 0.9 l/min/m2). In Group 1, the duration of ventilation support and time in the intensive care unit of responding patients was shorter. QRS duration before surgery was not predictive for the response to biventricular pacing. Conclusions: In the majority of patients with reduced LV function, temporary biventricular pacing improves CO and arterial blood pressure after surgery, especially when LV dilatation is present.
Key words
biventricular pacing - heart failure - cardiopulmonary bypass
References
-
1
Vinereanu D, Turner M S, Bleasdale R A. et al .
Mechanisms of reduction of mitral regurgitation by cardiac resynchronization therapy.
J Am Soc Echocardiogr.
2007;
20
54-62
-
2
Shamim W, Yousufuddin M, Cicoria M, Gibson D G, Coats A J, Henein M Y.
Incremental changes in QRS duration in serial ECGs over time identify high risk elderly patients with heart failure.
Heart.
2002;
88
47-51
-
3
Ikeoka K, Tanimoto M, Nomoto Y. et al .
Interventricular septal wall motion abnormality in left bundle branch block.
Am J Cardio.
1987;
17
887-894
-
4
Galderisi M, Cicala S, Sangiorgi G, Caso P, de Divitiis O.
Tissue Doppler-derived postsystolic motion in a patient with left bundle branch block: a sign of myocardial wall asynchrony.
Echocardiography.
2002;
19
79-81
-
5
Shamim W, Francis D P, Yousufuddin M. et al .
Intraventricular conduction delay: a prognostic marker in chronic heart failure.
Int J Cardiol.
1999;
70
171-178
-
6
Cazeau S, Ritter P, Lazarus A. et al .
Multisite pacing for end-stage heart failure: early experience.
Pacing Clin Electrophysiol.
1996;
19
1748-1757
-
7
Mansourati J, Etienne Y, Gilard M. et al .
Left ventricular-based pacing in patients with chronic heart failure: comparison of acute hemodynamic benefits according to underlying heart disease.
Eur J Heart Fail.
2000;
2
195-199
-
8
Kleine P, Doss M, Aybek T, Moritz A.
Biventricular pacing for weaning from extracorporeal circulation in heart failure.
Ann Thorac Surg.
2002;
73
960-962
-
9
Abdel-Rahman U, Kleine P, Seitz U, Moritz A.
Biventricular pacing for successful weaning from extracorporal circulation in an infant with complex tetralogy of Fallot.
Pediatr Cardiol.
2002;
23
553-554
-
10 Sachs L. Angewandte Statistik. Chapter 36. 8th edn. Berlin; Springer 1997: 345-356
-
11
Dzemali O, Bakhtiary F, Wittlinger T. et al .
Hemodynamic effects of left ventricular pacing site in an animal model of heart failure.
Thorac Cardiovasc Surg.
2007;
55 (Suppl 1)
24
-
12
Kleine P, Doss M, Aybek T, Wimmer-Greinecker G, Moritz A.
Biventricular pacing for weaning from extracorporeal circulation.
Ann Thorac Surg.
2002;
73
960-962
Dr. MD Omer Dzemali
Department for Cardiothoracic Surgery
J. W. Goethe University Hospital
Theodor-Stern-Kai 7
60590 Frankfurt am Main
Germany
Telefon: + 49 6 96 30 18 32 05
Fax: + 49 6 96 30 18 71 42
eMail: dzemali@em.uni-frankfurt.de
