title: Acute hemodynamic benefits of biventricular and single-site systemic ventricular pacing in patients with a systemic right ventricle.
abstract: BACKGROUND
  Patients treated by atrial redirection surgery (Senning or Mustard procedure) for transposition of the great arteries (TGA) have an important risk for heart failure caused by dysfunction of the systemic right ventricle. Conventional nonsystemic ventricular pacing (non-systVP) may even further increase this risk.
  
  
  OBJECTIVE
  We investigated the effects of endocardial non-systVP, biventricular pacing (BiVP), and single-site systemic ventricular pacing (systVP) on systolic cardiac pump function in patients with TGA and status post atrial redirection surgery (SenningMustardTGA).
  
  
  METHODS
  During clinically indicated catheterization in 9 patients with SenningMustardTGA, endocardial ventricular stimulation (overdrive DDD mode; 80-90 beats/min) was applied with temporary pacing leads at the nonsystemic and the systemic ventricle. Acute changes in the maximal rate of pressure rise (dP/dtmax) and systolic pressure of the systemic ventricle, as induced by non-systVP, systVP, and BiVP compared to reference, were assessed with a pressure wire within the systemic ventricle. Reference was AAI pacing with a similar heart rate (n = 7) or non-systVP at a lower heart rate than that during stimulation at experimental sites (85 beats/min vs 90 beats/min; n = 2).
  
  
  RESULTS
  Systemic dP/dtmax and systolic ventricular pressure were significantly higher during systVP (+15.6% and +5.1%, respectively) and BiVP (+14.3% and +4.9%, respectively, compared with non-systVP). In 6 of 7 patients, systemic dP/dtmax was higher during BiVP and systVP than during AAI pacing.
  
  
  CONCLUSIONS
  In a population of patients with SenningMustardTGA, acute hemodynamic effects of endocardial systVP and BiVP were significantly and equally better than those of non-systVP. In some patients, systVP and BiVP might even be better than ventricular activation by the intrinsic conduction system.
authors: Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Bordeaux, France. i.vangeldorp@maastrichtuniversity.nl
authors: Irene E
authors: IE
authors: van Geldorp
authors: Pierre
authors: P
authors: Bordachar
authors: Joost
authors: J
authors: Lumens
authors: Maxime
authors: M
authors: de Guillebon
authors: Zachary I
authors: ZI
authors: Whinnett
authors: Frits W
authors: FW
authors: Prinzen
authors: Michel
authors: M
authors: Haïssaguerre
authors: Tammo
authors: T
authors: Delhaas
authors: Jean-Benoît
authors: JB
authors: Thambo
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D014188:Transposition of Great Vessels / Q000503:physiopathology* / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology* / Q000628:therapy; D055815:Young Adult