title: Optimized perioperative biventricular pacing in setting of right heart failure.
abstract: OBJECTIVE
  A 78-year-old female with prior atrioventricular junctional ablation for paroxysmal atrial fibrillation and implantation of DDDR pacemaker underwent repair of severe tricuspid insufficiency. Effects of biventricular pacing were tested with temporary wires at the conclusion of cardiopulmonary bypass.
  
  
  METHODS
  An ultrasonic flow probe was placed on the ascending aorta for real time cardiac output measurements. Atrioventricular delay optimization was performed and biventricular pacing was initiated while right-left ventricular delays were varied.
  
  
  RESULTS
  There was no advantage of biventricular pacing (optimum right-left ventricular delay of +80 ms) compared with existing DDD.
  
  
  CONCLUSIONS
  This study confirms the physiological effects of right-left ventricular delay on cardiac output after cardiopulmonary bypass.
authors.affiliation: Department of Surgery, Columbia University, College of Physicians and Surgeons, 622 West 168th Street, PH 14-103, New York, NY 10032, USA. gb2128@columbia.edu
authors.forename: George
authors.initials: G
authors.lastname: Berberian
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Kanter
authors.forename: T Alexander
authors.initials: TA
authors.lastname: Quinn
authors.forename: Henry M
authors.initials: HM
authors.lastname: Spotnitz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D010138:Pacemaker, Artificial; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*