Coronary artery bypass grafting with concomitant cardiac resynchronisation therapy in patients with ischaemic heart failure and left ventricular dyssynchrony☆

Pokushalov, Evgeny; Romanov, Alexander; Prohorova, Darya; Cherniavsky, Alexander; Gościńska-Bis, Kinga; Bis, Jarosław; Bochenek, Andrzej; Karaskov, Alexander

doi:10.1016/j.ejcts.2010.03.036

Cited by 17 publications

(14 citation statements)

References 21 publications

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“…Similar results have been found in patients with both ischemic and non-ischemic heart disease [2]. Although CABG itself neither eliminates dyssynchrony nor improves systolic function, epicardial implantation of a CRT system concomitant with CABG facilitates patient management in the early postoperative period and improves LV systolic function [3]. …”

Section: Discussionsupporting

confidence: 58%

Cardiac Resynchronization Therapy Using a Dual Chamber Pacemaker in Patients with Severe Left Ventricular Dysfunction and a Left Bundle Branch Block

Jung

Kim

Jeong

et al. 2013

Korean J Thorac Cardiovasc Surg

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Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease. Her electrocardiogram showed a left bundle branch block (LBBB) and a prolonged QRS interval of 166 milliseconds. Severe left ventricle (LV) dysfunction was diagnosed via echocardiography. Coronary artery bypass grafting (CABG) was then performed. In order to accelerate left atrial activation and reduce the conduction defect, DDD pacing using right atrial and left and right ventricular pacing wires was initiated postoperatively. The cardiac output was measured immediately, and one and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing. The biventricular synchronization using DDD pacing was turned off 18 hours after surgery. She was transferred to a general ward with a cardiac output of 3.9 L/min. In patients with coronary artery disease, severe LV dysfunction, and LBBB, cardiac resynchronization therapy can be achieved through DDD pacing after CABG.

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Section: Discussionsupporting

confidence: 58%

Cardiac Resynchronization Therapy Using a Dual Chamber Pacemaker in Patients with Severe Left Ventricular Dysfunction and a Left Bundle Branch Block

Jung

Kim

Jeong

et al. 2013

Korean J Thorac Cardiovasc Surg

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“…In a small study on CRT with epicardial leads during CABG in patients with HF [12], a better estimated QoL was seen in patients with active CRT. Similarly, CRT improved QoL and LV systolic function after CABG in HF patients with ventricular dyssynchrony [13]. …”

Section: Discussionmentioning

confidence: 99%

“…The surgical technique results in more successful left lead positioning, same level of clinical improvement, lower left ventricular (LV) related complication rates and lower chronic threshold-capture compared to transvenous lead placement via the coronary sinus [10,11]. Perioperative CRT-implantation in CABG patients seems to carry a positive effect on functional status and QoL in addition to the outcome of surgery [12,13]. The information available on concomitant CRT-implantation in association with cardiac surgery is, however, limited.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Concomitant Cardiac Resynchronization Therapy on Quality of Life in Patients with Heart Failure Undergoing Cardiac Surgery

Thorén¹,

Kesek²,

Jidéus³

2014

TOCMJ

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Objectives:To evaluate the effect of concomitant cardiac resynchronization therapy (CRT) on health related quality of life (QoL) in patients with heart failure (HF) and ventricular dyssynchrony undergoing cardiac surgery.Methods:Twenty-eight patients received permanent epicardial CRT in connection to coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) (CRT group). Thirty-seven HF patients without concomitant CRT served as a comparison group (non-CRT group). SF-36 was used to assess QoL in the two groups and was also compared with the general Swedish population.Results:The median follow-up time was 28 months after surgery (range 8 to 44 months). No difference in QoL could be shown between the CRT group and the comparison group. Several subscales of QoL in the CRT group were in range with the general Swedish population.Conclusion:Concomitant CRT for patients with HF and ventricular dyssynchrony undergoing CABG and/or AVR did not result in a higher estimated QoL compared to HF patients without CRT.

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“…We elected to use the duration of Level 3 care rather than the duration of intensive care to reduce the potential for confounding variables in the primary end-point. Currently, only one trial ( n = 178) has reported a significant reduction in intensive care stay after cardiac surgery with permanent BiV pacing compared with no BiV pacing [5]. However, the duration of Level 3 care in the BiV pacing group in our study was significantly shorter than in the previous study (40.4 ± 35.0 vs 60.0 ± 12 h; P = 0.02) [5].…”

Section: Discussionmentioning

confidence: 99%

“…This is achieved by attaching temporary pacing wires to the right atrium (RA), right ventricle (RV) and LV before closing the sternum. Previous studies of permanent BiV pacing have reported acute improvements in haemodynamic function [1–4] but attempts to reproduce these findings acutely after cardiac surgery have produced mixed results [5–10]. In addition, one postoperative study has reported no improvement in coronary conduit flow with BiV pacing compared with atrial synchronous RV pacing [11].…”

Section: Introductionmentioning

confidence: 99%

Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

Russell

Tan

O’Keefe

et al. 2012

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESOptimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care.METHODSThirty-eight patients in sinus rhythm, ejection fraction ≤35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes.RESULTSThe duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005).CONCLUSIONSPostoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery.

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Coronary artery bypass grafting with concomitant cardiac resynchronisation therapy in patients with ischaemic heart failure and left ventricular dyssynchrony☆

Cited by 17 publications

References 21 publications

Cardiac Resynchronization Therapy Using a Dual Chamber Pacemaker in Patients with Severe Left Ventricular Dysfunction and a Left Bundle Branch Block

Cardiac Resynchronization Therapy Using a Dual Chamber Pacemaker in Patients with Severe Left Ventricular Dysfunction and a Left Bundle Branch Block

The Effect of Concomitant Cardiac Resynchronization Therapy on Quality of Life in Patients with Heart Failure Undergoing Cardiac Surgery

Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

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