title: Temporary and permanent biventricular pacing via left ventricular epicardial leads implanted during primary cardiac surgery.
abstract: OBJECTIVE
  Biventricular pacing (BVP) is a new strategy for treating patients with severe congestive heart failure (CHF) and intraventricular conduction delay, but its full potential and technicalities of BVP require further evaluation. We evaluated BVP benefits in 4 patients in whom we implanted a left ventricular lead during primary cardiac surgery.
  
  
  METHODS
  Four CHF patients treated surgically between October 2000 and August 2001 underwent, at primary surgery, the implantation of leads in the right atrium, right ventricle, and left ventricle (LV) for postsurgical BVP. All patients had severe LV dysfunction and dilatation with intraventricular conduction delay. Surgeries involved CABG alone (n = 1), CABG + Dor's operation (n = 2), and tricuspid valve replacement + Maze procedure (n = 1). BVP was begun immediately after surgery in all 4 patients. Hemodynamic variables with BVP were compared to those without BVP for each patient, and the utility and technical aspects of implantation were evaluated.
  
  
  RESULTS
  BVP increased mean systemic blood pressure by 11% and mean LV stroke work index by 19% in the acute postsurgery period, and reduced mitral regurgitation. Two of the patients were implanted with a generator for permanent BVP, one at 1 month and the other at 6 months after surgery. The threshold of the LV epicardial lead of these 2 patients was below 2 V during follow-up, and BVP was successful.
  
  
  CONCLUSIONS
  Temporary BVP during the short-term after cardiac surgery improved cardiac function and decreased mitral regurgitation in all 4 of our patients. Epicardial lead implantation may thus be a useful option during surgical treatment of patients with CHF and intraventricular conduction delay if long-term permanent BVP is indicated.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Mizuno
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kuriu
authors.forename: Fusahiko
authors.initials: F
authors.lastname: Itoh
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.forename: Hideki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Tabuchi
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Arai
authors.forename: Makoto
authors.initials: M
authors.lastname: Sunamori
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy; D010496:Pericardium