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    Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient.

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    Authors
    Healy, David G
    Hargrove, Martin
    Doddakulla, Kishore
    Hinchion, John
    O'Donnell, Aongus
    Aherne, Thomas
    Affiliation
    Department of Cardiothoracic Surgery, Cork University Hospital, Wilton, Cork,, Ireland. cardiothoracic@gmail.com
    Issue Date
    2012-02-03T15:09:29Z
    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
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    Metadata
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    Citation
    Interact Cardiovasc Thorac Surg. 2008 Oct;7(5):805-8. Epub 2008 Jun 9.
    Journal
    Interactive cardiovascular and thoracic surgery
    URI
    http://hdl.handle.net/10147/208996
    DOI
    10.1510/icvts.2008.180497
    PubMed ID
    18541607
    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)
    ae974a485f413a2113503eed53cd6c53
    10.1510/icvts.2008.180497
    Scopus Count
    Collections
    Cork University Hospital

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