Key result
Atrio-biventricular pacing increased cardiac index and decreased wedge pressure compared with AAI pacing in patients with poor left-ventricular function after CABG.
Why the study?
Does atrio-biventricular pacing improve postoperative haemodynamics compared to atrial pacing in patients with poor left-ventricular function after CABG?
Does atrio-biventricular pacing improve postoperative haemodynamics compared to atrial pacing in patients with poor left-ventricular function after CABG?
Site-specific temporary epicardial pacing, particularly atrio-biventricular pacing, optimizes early postoperative hemodynamics in patients with poor LV function undergoing CABG.
May support atrio-biventricular pacing for hemodynamic benefit post-CABG in poor LV function; leaves open need for randomized outcome trials.
AIMS: The relation between acute postoperative management of epicardial pacing and haemodynamic status in patients with poor left-ventricular function after coronary artery bypass grafting (CABG) demonstrates the importance of synchronous ventricular activation and contraction during the vulnerable early postoperative period. METHODS: in 22 patients (mean age - 69.3 +/- 5.4 years) with poor left-ventricular function (ejection fraction 29.8 +/- 4.8), we compared the postoperative haemodynamic parameters between atrio-biventricular, atrio-monoventricular and atrial pacing 3 - 24 hours after elective coronary artery revascularisation. Temporary epicardial pacing electrodes were placed on the right atrium and the paraseptal region of the left and right ventricle. The ventricular pacing modus was confirmed by surface electrocardiogram (EGG). We used overdrive rate pacing. RESULTS: In patients with left bundle branch block, atrio-left-ventricular and atrio-biventricular pacing increased cardiac index and decreased wedge pressure. Atrial pacing and atrio-right-ventricular pacing decreased cardiac index. In contrast, atrio-right-ventricular and atrio-biventricular pacing increased cardiac index in patients with right bundle brunch block. CONCLUSION: Atrio-biventricular pacing increased cardiac index and decreased wedge pressure compared with AAI pacing. In patients with wall-motion abnormalities and impaired cardiac conduction, a site-specific pacing therapy can help to optimize postoperative haemodynamics and reduce the application of inotropic substances.
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Weisse et al. (2002) studied Poor left-ventricular function after coronary artery bypass grafting (CABG) (n=22). Atrio-biventricular pacing vs. Atrial pacing (AAI) and atrio-monoventricular pacing was evaluated on Postoperative haemodynamic parameters (cardiac index and wedge pressure). Atrio-biventricular pacing increased cardiac index and decreased wedge pressure compared with AAI pacing in patients with poor left-ventricular function after CABG.
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