title: Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass.
abstract: BACKGROUND
  To evaluate, with different pacing modes, acute changes in left ventricular systolic function, obtained by continuous cardiac output thermodilution in various subsets of patients undergoing cardiopulmonary bypass surgery. Increments of mean arterial pressure and cardiac output were considered the end point.
  
  
  METHODS
  Fifty cases electively submitted to cardiac surgery were analyzed. Isolated valve surgery 62%, coronary revascularization 30% and 8% mixed disease. Left ventricular ejection fraction was preserved in 50%,36% had moderate depression,(EF 36%-50%) whereas 14% had severe depression (EF < 35%). Left bundle branch block occurred in 18%. Preoperatively 84% were in sinus rhythm and 16% in atrial fibrillation. The different subgroups were analyzed for comparisons. Right atrial-right ventricular and right atrial-left ventricular pacing were employed in sinus rhytm. Biventricular pacing was also used in atrial fibrillation.
  
  
  RESULTS
  Right atrium-right ventricular pacing, decreased significantly mean arterial pressure and cardiac output (2.3%) in the overall population and in the subgroups studied. Right atrium-left ventricle, increased mean arterial pressure and cardiac output in 79% of patients and yielded cardiac output increments of 7.5% (0.40 l/m) in the low ejection fraction subgroup and 7.3% (0.43 l/m) in the left bundle branch block subset. In atrial fibrillation patients, left ventricular and biventricular pacing produced a significant increase in cardiac output 8.5% (0.39 l/min) and 11.6% (0.53 l/min) respectively. The dP/dt max increased significantly with both modes (p = 0.021,p = 0.028).
  
  
  CONCLUSIONS
  Right atrial-right ventricular pacing generated adverse hemodynamic effects. Right atrium-left ventricular pacing produced significant CO improvement particularly in cases with depressed ventricular function and left bundle branch block. The greatest increments were observed with left ventricular or biventricular pacing in atrial fibrillation with depressed ejection fraction.
authors.affiliation: Cardiac Surgical Division, Department of Surgery, Hospital Clínico Universitario, 15706, Santiago de Compostela, Spain. alfg@secardiologia.es
authors.forename: Jose B
authors.initials: JB
authors.lastname: García-Bengochea
authors.forename: Angel L
authors.initials: AL
authors.lastname: Fernández
authors.forename: Daniel Sánchez
authors.initials: DS
authors.lastname: Calvelo
authors.forename: Julian Alvarez
authors.initials: JA
authors.lastname: Escudero
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude
authors.forename: José R González
authors.initials: JR
authors.lastname: Juanatey
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric