Perioperative biventricular pacing leads to improvement of hemodynamics in patients with reduced left-ventricular function--interim results.
BACKGROUND
Cardiac resynchronization therapy (CRT) has been introduced as a new therapeutic modality in patients with chronic heart failure. However, most studies have investigated the hemodynamic effects in congestive, but not postoperative heart failure.


OBJECTIVE
The following study investigates hemodynamic effects of perioperative temporary biventricular pacing in patients undergoing open heart surgery. In 54 patients one left and one right ventricular epicardial wire was placed during open heart operations. Hemodynamic parameters were measured immediately after the operation and 6 as well as 24 hours postoperatively. Transesophageal echocardiography was performed 1 hour postoperatively.


RESULTS
Of the 54 patients (59.2%), 32 responded to biventricular pacing with an increase in cardiac output; in these patients synchronized ventricular contraction could be verified echocardiographically. This hemodynamic benefit persisted 6 hours and 24 hours postoperatively. The remaining 22 patients did not show any hemodynamic improvement from biventricular stimulation.


CONCLUSIONS
Biventricular pacing leads to significant rise in cardiac output in approximately 59% of patients with severely reduced left ventricular function and widened QRS complexes. Further studies are necessary to define clearly the clinical characteristics of patients who show remodeling by CRT.
Dzemali
Omer
O
Department of Thoracic and Cardiovascular Surgery, University Hospital, J.W. Goethe University, Frankfurt/Main, Germany. dzemali@em.uni-frankfurt.de
Bakhtiary
Farhad
F
Dogan
Selami
S
Wittlinger
Thomas
T
Moritz
Anton
A
Kleine
Peter
P
D000368:Aged; D001783:Blood Flow Velocity; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003326:Coronary Circulation; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000517:prevention & control*