Acute hemodynamic effects of cardiac resynchronization therapy in patients with poor left ventricular function during cardiac surgery

Hamad, Mohamed A. Soliman, van Gelder, Berry M., Bracke, Frank A., van Zundert, Andre A. J. and van Straten, Albert H. M. (2009) Acute hemodynamic effects of cardiac resynchronization therapy in patients with poor left ventricular function during cardiac surgery. Journal of Cardiac Surgery, 24 5: 585-590. doi:10.1111/j.1540-8191.2009.00878.x


Author Hamad, Mohamed A. Soliman
van Gelder, Berry M.
Bracke, Frank A.
van Zundert, Andre A. J.
van Straten, Albert H. M.
Title Acute hemodynamic effects of cardiac resynchronization therapy in patients with poor left ventricular function during cardiac surgery
Journal name Journal of Cardiac Surgery   Check publisher's open access policy
ISSN 0886-0440
1540-8191
Publication date 2009-01-01
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1540-8191.2009.00878.x
Volume 24
Issue 5
Start page 585
End page 590
Total pages 6
Place of publication Hoboken, NJ United States
Publisher Wiley-Blackwell Publishing
Language eng
Abstract Background: Cardiac resynchronization therapy improves systolic function in patients with heart failure and left ventricular (LV) dyssynchrony. However, the effect of biventricular (BiV) pacing on perioperative hemodynamics in cardiac surgery is not well known. We investigated the acute hemodynamic response using LVdP/dtmax in patients with depressed LV function and conduction disturbances undergoing cardiac surgery. Methods: Patients with LV ejection fraction of ≤35%, QRS duration of >130 ms, and left bundle branch block undergoing aortocoronary bypass and valve surgery were included. Temporary atrial and left and right ventricular pacing wires were applied, and LVdP/dtmax was measured with a high fidelity pressure wire in the left ventricle at the end of cardiopulmonary bypass. Responders had a ≥10% increase in LVdP/dtmax. Results: Eleven patients (age 63 ± 11 years, eight males) with a LV ejection fraction 0.29 ± 0.06% were included. Compared with right ventricular pacing (782 ± 153 mmHg/sec), there was a significant improvement in the mean LVdP/dtmax during simultaneous BiV pacing (849 ± 174 mmHg/sec; p = 0.034) and sequential BiV pacing with the LV 40 ms advanced (880 ± 157 mmHg/sec; p = 0.003). Improvement during LV pacing alone was not significant (811 ± 141 mmHg/sec). Six patients were responders with simultaneous and nine with sequential BiV pacing. Only sequential BiV pacing had a significant improvement in LV systolic pressure (p = 0.02). Conclusions: BiV pacing results in acute hemodynamic improvement of LV function during cardiac surgery. Optimization of the interventricular pacing interval contributes to the effect of the therapy.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Thu, 21 May 2015, 00:58:52 EST by Andre Van Zundert on behalf of Anaesthesiology and Critical Care - RBWH