Key result
Temporary right ventricular outflow tract pacing provided significantly higher bypass graft flows (59.9 mL/min) compared to other ventricular pacing sites (p < 0.05) in CABG patients with AF.
Why the study?
Does temporary epicardial pacing at the RVOT improve bypass graft flow compared to other ventricular pacing sites in patients with atrial fibrillation following CABG?
Does temporary epicardial pacing at the RVOT improve bypass graft flow compared to other ventricular pacing sites in patients with atrial fibrillation following CABG?
Temporary RVOT pacing provides optimal bypass graft flows compared to other ventricular sites in patients with atrial fibrillation following CABG.
Should not yet change temporary pacing site selection post-CABG; hypothesis-generating for RVOT optimization and requires randomized confirmation.
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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Madershahian et al. (2009) studied Atrial fibrillation following coronary artery bypass surgery (n=23). Right ventricular outflow tract (RVOT) pacing vs. Other ventricular pacing sites (RVPS, RVIW, LVPS) was evaluated on Bypass graft flow (p=<0.05). Temporary right ventricular outflow tract pacing provided significantly higher bypass graft flows (59.9 mL/min) compared to other ventricular pacing sites (p < 0.05) in CABG patients with AF.
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