Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient.
Healy, David G Hargrove, Martin Doddakulla, Kishore Hinchion, John O'Donnell, Aongus Aherne, Thomas
Healy, David G
Hargrove, Martin
Doddakulla, Kishore
Hinchion, John
O'Donnell, Aongus
Aherne, Thomas
Advisors
Editors
Other Contributors
Date
2012-02-03T15:09:29Z
Date Submitted
Keywords
Other Subjects
Subject Mesh
Aged
Blood Flow Velocity
*Cardiac Output
Cardiac Pacing, Artificial/*methods
*Coronary Artery Bypass
*Coronary Circulation
Coronary Vessels/physiopathology/*surgery/ultrasonography
Female
Humans
Male
Middle Aged
Prospective Studies
Stroke Volume
Vascular Patency
Blood Flow Velocity
*Cardiac Output
Cardiac Pacing, Artificial/*methods
*Coronary Artery Bypass
*Coronary Circulation
Coronary Vessels/physiopathology/*surgery/ultrasonography
Female
Humans
Male
Middle Aged
Prospective Studies
Stroke Volume
Vascular Patency
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
We have previously demonstrated the role of univentricular pacing modalities in influencing coronary conduit flow in the immediate post-operative period in the cardiac surgery patient. We wanted to determine the mechanism of this improved coronary conduit and, in addition, to explore the possible benefits with biventricular pacing. Sixteen patients undergoing first time elective coronary artery bypass grafting who required pacing following surgery were recruited. Comparison of cardiac output and coronary conduit flow was performed between VVI and DDD pacing with a single right ventricular lead and biventricular pacing lead placement. Cardiac output was measured using arterial pulse waveform analysis while conduit flow was measured using ultrasonic transit time methodology. Cardiac output was greatest with DDD pacing using right ventricular lead placement only [DDD-univentricular 5.42 l (0.7), DDD-biventricular 5.33 l (0.8), VVI-univentricular 4.71 l (0.8), VVI-biventricular 4.68 l (0.6)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.023) and VVI-biventricular pacing (P=0.001) but there was no significant advantage to DDD-biventricular pacing (P=0.45). In relation to coronary conduit flow, DDD pacing again had the highest flow [DDD-univentricular 55 ml/min (24), DDD-biventricular 52 ml/min (25), VVI-univentricular 47 ml/min (23), VVI-biventricular 50 ml/min (26)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.006) pacing but not significantly different to VVI-biventricular pacing (P=0.109) or DDD-biventricular pacing (P=0.171). Pacing with a DDD modality offers the optimal coronary conduit flow by maximising cardiac output. Biventricular lead placement offered no significant benefit to coronary conduit flow or cardiac output.
Language
eng
ISSN
1569-9285 (Electronic)
1569-9285 (Linking)
1569-9285 (Linking)
eISSN
ISBN
DOI
10.1510/icvts.2008.180497
PMID
18541607