Temporary left ventricular pacing improves haemodynamic performance in patients requiring epicardial pacing post cardiac surgery

OBJECTIVE: In the 1990s, sequential atrio-ventricular pacing demonstrated haemodynamic benefit relative to right ventricular pacing in patients with sinus rhythm requiring pacing post cardiopulmonary bypass. The benefit of biventricular pacing has been demonstrated in non-surgical patients with severe left ventricular dysfunction. It was hypothesised that left ventricular pacing would increase cardiac output in surgical patients. We report the findings of a prospective trial of left ventricular pacing with active lead placement on the anterior or posterior left ventricular surface, compared to standard practice of active lead placement on the right ventricular surface. METHODS: Twenty five patients with left ventricular dysfunction underwent pacing with active lead placement on the right ventricle (control), the anterior left ventricle and the posterior left ventricle in random order, with each pacing mode of 10 min duration, following cardiopulmonary bypass. Haemodynamic parameters were measured with a thermodilution pulmonary artery catheter. Patients provided their control values. RESULTS: In the 25 patients studied, pacing with the active lead posteriorly on the left ventricle increased cardiac index from 2.74 to 3.08 l/min per m2 (P=0.019). Significant increases in mean arterial pressure with the use of this pacing mode were observed. There were no complications relating to application or removal of the left ventricle pacing leads. CONCLUSIONS: Left ventricular pacing with active lead placed on the postero-lateral left ventricular wall affords haemodynamic benefit to cardiac surgical patients.