title: The impact of atrio-biventricular pacing on hemodynamics and left ventricular dyssynchrony compared with atrio-right ventricular pacing alone in the postoperative period after cardiac surgery.
abstract: OBJECTIVE
  The aims of this study were to test the hypotheses that in the postoperative period after coronary artery bypass graft surgery (1) atrio-right ventricular (RA-RV) pacing induces a decrease in cardiac output compared with RA pacing alone and (2) atrio-biventricular (RA-BiV) pacing improves CO compared with RA-RV pacing.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A single-center university hospital.
  
  
  METHODS
  Patients referred for coronary artery bypass graft surgery.
  
  
  METHODS
  Patients were studied during atrial, RA-RV, and RA-BiV pacing. Cardiac output (echocardiography) and left ventricular dyssynchrony were assessed at each step.
  
  
  RESULTS
  RA-RV pacing induced a significant decrease in cardiac output (4.3 +/- 1.0 to 3.7 +/- 0.8 L/min, p < 0.01) and a significant increase in left ventricular dyssynchrony (13 +/- 12 to 80 +/- 25 milliseconds, p < 0.01). Biventricular pacing induced a significant increase in cardiac output (3.7 +/- 0.8 to 4.5 +/- 1.0 L/min, p < 0.01) and a significant decrease in left ventricular dyssynchrony compared with right ventricular pacing (80 +/- 25 to 21 +/- 16 milliseconds, p < 0.05).
  
  
  CONCLUSIONS
  RA-BiV pacing improves cardiac output compared with RA-RV pacing in the postoperative period after coronary artery bypass graft surgery. This improvement is related to an improvement in left ventricular synchronicity.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Louis Pradel Hospital, Claude Bernard Lyon 1 University, Lyon, France. maxime_cannesson@hotmail.com
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
authors.forename: Fadi
authors.initials: F
authors.lastname: Farhat
authors.forename: Maria
authors.initials: M
authors.lastname: Scarlata
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cassar
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lehot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right / Q000502:physiology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology* / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology*