Four-Chamber Pacing in Patients with Poor Ejection Fraction but Normal QRS Durations Undergoing Open Heart Surgery

Autor:	Gunnar Klein, Omke Teebken, Axel Haverich, Maximilian Pichlmaier, Eric Bagaev, Michael Niehaus, Arthur Lichtenberg
Rok vydání:	2008
Předmět:	medicine.medical_specialty Ejection fraction business.industry Cardiac index Hemodynamics General Medicine Surgery Cardiac surgery QRS complex Bypass surgery Internal medicine Anesthesia cardiovascular system medicine Cardiology In patient cardiovascular diseases Risk factor Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 31:184-191
ISSN:	0147-8389
DOI:	10.1111/j.1540-8159.2007.00967.x
Popis:	Background:Poor ejection fraction (EF) comprises a critical risk factor in cardiac bypass surgery (CABG). It has been unclear, whether biventricular or four-chamber pacing confers benefit upon patients with intact atrioventricular and interventricular conduction especially following surgery. Methods:Twenty-one consecutive patients with an EF ≤ 35% underwent hemodynamic evaluation (continuous pressures and thermodilution) 3, 6, and 18 hours post-CABG and biatrial (AA), biatrial-right ventricular (AAV), and biatrial-biventricular (AAVV) pacing were compared. Results:Patients (65 ± 9 years) presented with an average EF of 29.5% (15–35%). 514 measurements of cardiac index (CI) were taken. Nineteen patients (91%) showed highly significant increases in CI with AAVV as compared to AA pacing (P < 0,001) at all times post surgery. The increase in CI with pacing mode varied from 6% to 25% and decreased with time following surgery. No consistent difference in CI was seen between four-chamber (AAVV) and biventricular pacing (AVV). The QRS-widths prior to surgery never exceeded 120 ms; postoperatively QRS-complexes widened in all patients on average by 15.9 ms ±6 and returned to starting values by 48 hours. Conclusions:Biventricular pacing improves CI in patients with poor EF following cardiac surgery in the absence of preoperative atrioventricular- or interventricular conduction block. This benefit decreases with time after surgery as the QRS width returns to preoperative values. Four-chamber pacing did not confer additional benefit as compared to biventricular pacing in this series. Biventricular pacing should be considered as an adjunct in patients with critically low EF undergoing cardiac surgery.
Databáze:	OpenAIRE
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