title: Impact of biventricular and left ventricular pacing on hemodynamics and left ventricular dyssynchrony compared with right ventricular pacing in the early postoperative period following cardiac surgery.
abstract: OBJECTIVE
  The aims of this study were to test the hypotheses that in the postoperative period following corrective surgery for congenital heart defects: (i) atrio-right ventricular (RA-RV) pacing decreases cardiac output (CO) compared with right atrial (RA) pacing, (ii) atrio-biventricular (RA-BiV) and left ventricular (RA-LV) pacing improves CO compared with RA-RV pacing.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Children 0-2years of age referred for surgery of congenital heart defects were studied during intrinsic rhythm and atrial, atrio-right ventricular, atrio-left ventricular and atrio-biventricular pacing. CO, extrapolated from mean systolic aortic velocity (MSAV), and left ventricular dyssynchrony were assessed using transthoracic echocardiography.
  
  
  RESULTS
  RA-RV pacing induced a significant decrease in CO (MSAV 0.52±0.19m/s to 0.46±0.16m/s, p=0.01) and a significant increase in LV dyssynchrony (8.7±7.9ms to 33±21ms, p=0.001). RA-BiV pacing induced a significant increase in CO (MSAV 0.46±0.16m/s to 0.52±0.18m/s, p=0.01) and a significant decrease in LV dyssynchrony (33±21ms to 7±4ms, p=0.0003) compared with RA-RV pacing. RA-LV pacing induced a significant decrease in LV dyssynchrony (33±21ms to 9±7ms, p=0.0007) without a significant improvement of CO compared with RA-RV pacing.
  
  
  CONCLUSIONS
  RA-BiV pacing improves CO compared with RA-RV pacing in the early postoperative period following pediatric cardiac surgery. This improvement is related to a reduction in left ventricular dyssynchrony.
authors.affiliation: Service d'anesthésie réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, 28 avenue du Doyen-Lépine, Lyon-Bron, Lyon, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Vichova
authors.forename: R
authors.initials: R
authors.lastname: Hénaine
authors.forename: M C
authors.initials: MC
authors.lastname: Basto Duarte
authors.forename: J-J
authors.initials: JJ
authors.lastname: Lehot
authors.forename: M
authors.initials: M
authors.lastname: Cannesson
mesh_terms: D001283:Atrioventricular Node; D002302:Cardiac Output / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D016278:Ventricular Function, Right
chemical_list: D002316:Cardiotonic Agents