Temporary and permanent biventricular pacing via left ventricular epicardial leads implanted during primary cardiac surgery

Tanaka, Hiroyuki; Okishige, Kaoru; Mizuno, Tomohiro; Kuriu, Kazuyuki; Itoh, Fusahiko; Shimizu, Masato; Akamatsu, Hideki; Tabuchi, Noriyuki; Arai, Hirokuni; Sunamori, Makoto

doi:10.1007/bf03032296

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…We found BiVP ineffective after primary coronary bypass or primary mitral surgery, consistent with previous studies [16–28]. …”

Section: Commentsupporting

confidence: 92%

“…BiPACS [3,4,13,32–34] and previous studies [16–28] suggest that future pacing research should focus on aortic valve surgery and should distinguish benefits of rate acceleration from resynchronization. This may confirm whether the complexity of BiVP is justified, or whether accelerated heart rate alone is sufficient.…”

Section: Commentmentioning

confidence: 99%

“…Development of BiVP involved surgically implanted epicardial leads [15], and surgical investigators have examined benefits of temporary BiVP for LV dysfunction after cardiopulmonary bypass with mixed results [3,4,16–28]. However, aside from limited examination of lead location [18,24,28] and VVD [25], formal optimization of BiVP had not been attempted in temporary pacing.…”

Section: Introductionmentioning

confidence: 99%

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Primary Endpoints of the Biventricular Pacing After Cardiac Surgery Trial

Spotnitz¹,

Cabreriza²,

Wang³

et al. 2013

The Annals of Thoracic Surgery

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Background To determine whether optimized biventricular pacing increases cardiac index in patients at risk of left ventricular dysfunction after cardiopulmonary bypass. Procedures included coronary artery bypass, aortic or mitral surgery and combinations. This trial was approved by the Columbia University Institutional Review Board and was conducted under an Investigational Device Exemption. Methods Screening of 6,346 patients yielded 47 endpoints. With informed consent, 61 patients were randomized to pacing or control groups. Atrioventricular and interventricular delays were optimized one (Phase I), two (Phase II), and 12–24 hours (Phase III) after bypass in all patients. Cardiac index was measured by thermal dilution in triplicate. Two-sample t-test assessed differences between groups and subgroups. Results Cardiac index was 12% higher (2.83±0.16 (S.E.M.) vs. 2.52±0.13 liters/minute/square meter) in the paced group, less than predicted and not statistically significant (p=0.14). However, when aortic and aortic/mitral surgery groups were combined, cardiac index increased 29% in the paced group (2.90±0.19, n=14) vs. controls (2.24±0.15, n=11) (p=0.0138). Using a linear mixed effects model, t-test revealed that mean arterial pressure increased with pacing vs. no pacing at all optimization points (Phase I 79.2±1.7 vs. 74.5±1.6 mmHg, p=0.008, Phase II 75.9±1.5 vs. 73.6±1.8, p=0.006, Phase III 81.9±2.8 vs. 79.5±2.7, p=0.002) Conclusions Cardiac index did not increase significantly overall but increased 29% after aortic valve surgery. Mean arterial pressure increased with pacing at three time points. Additional studies are needed to distinguish rate from resynchronization effects, emphasize atrioventricular delay optimization, and examine clinical benefits of temporary postoperative pacing.

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“…We found BiVP ineffective after primary coronary bypass or primary mitral surgery, consistent with previous studies [16–28]. …”

Section: Commentsupporting

confidence: 92%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Primary Endpoints of the Biventricular Pacing After Cardiac Surgery Trial

Spotnitz¹,

Cabreriza²,

Wang³

et al. 2013

The Annals of Thoracic Surgery

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show abstract

“…Correctly timing different chamber excitation, and restoration of the ventricular synchronized contraction and relaxation can improve cardiac performance. Anecdotally, we have been able to achieve a significant reduction of mitral regurgitation after initiation of BiV pacing, which has also been shown in other studies 14,15 . Additionally, this method has been anecdotally performed in patients with prolonged conduction and reduced systolic function in whom a postoperative permanent BiV pacemaker is planned.…”

supporting

confidence: 65%

Temporary Biventricular Pacing Postcardiopulmonary Bypass in Patients with Reduced Ejection Fraction

Muehlschlegel

Peng

Lobato

et al. 2008

Journal of Cardiac Surgery

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“…These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19,56) and congenital (27,40,47) heart disease.…”

mentioning

confidence: 99%

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Quinn

Berberian

Cabreriza

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Temporary sequential biventricular pacing (BiVP) is a promising treatment for postoperative cardiac dysfunction, but the mechanism for improvement in right ventricular (RV) dysfunction is not understood. In the present study, cardiac output (CO) was optimized by sequential BiVP in six anesthetized, open-chest pigs during control and acute RV pressure overload (RVPO). Ventricular contractility was assessed by the maximum rate of increase of ventricular pressure (dP/dt max). Mechanical interventricular synchrony was measured by the area of the normalized RV-left ventricular (LV) pressure diagram (A PP ). Positive A PP indicates RV pressure preceding LV pressure, whereas zero indicates complete synchrony. In the control state, CO was maximized with nearly simultaneous stimulation of the RV and LV, which increased RV (P ϭ 0.006) and LV dP/dt max (P ϭ 0.002). During RVPO, CO was maximized with RV-first pacing, which increased RV dP/dt max (P ϭ 0.007), but did not affect LV dP/dtmax, and decreased the left-to-right, end-diastolic pressure gradient (P ϭ 0.023). Percent increase of RV dP/dt max was greater than LV dP/dtmax (P ϭ 0.014). There were no increases in end-diastolic pressure to account for increases in dP/dt max. In control and RVPO, RV dP/dtmax was linearly related to A PP (r ϭ 0.779, P Ͻ 0.001). The relation of CO to APP was curvilinear, with a peak in CO with positive A PP in the control state (P ϭ 0.004) and with A PP approaching zero during RVPO (P ϭ 0.001). These observations imply that, in our model, BiVP optimization improves CO by augmenting RV contractility. This is mediated by changes in mechanical interventricular synchrony. Afterload increases during RVPO exaggerate this effect, making CO critically dependent on simultaneous pressure generation in the RV and LV, with support of RV contractility by transmission of LV pressure across the interventricular septum. ventricular mechanics; interventricular synchrony; cardiac output; perioperative pacing; cardiac resynchronization therapy BIVENTRICULAR PACING (BiVP), or cardiac resynchronization therapy, is an important evolving therapeutic modality for congestive heart failure, reversing intraventricular conduction delay and left ventricular (LV) dysfunction intrinsic to dilated cardiomyopathy (2). In addition to long-term benefits for cardiac function and geometry in patients with various forms of chronic heart failure, BiVP is associated with acute improvements in ventricular systolic and diastolic function, inter-and intraventricular synchrony, and cardiac output (CO), with no cost to energy consumption (2). These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19, 56) and congenital (27, 40, 47) heart disease.Studies investigating sequential BiVP by alteration of the interventricular pacin...

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Temporary and permanent biventricular pacing via left ventricular epicardial leads implanted during primary cardiac surgery

Cited by 17 publications

References 18 publications

Primary Endpoints of the Biventricular Pacing After Cardiac Surgery Trial

Primary Endpoints of the Biventricular Pacing After Cardiac Surgery Trial

Temporary Biventricular Pacing Postcardiopulmonary Bypass in Patients with Reduced Ejection Fraction

Effects of sequential biventricular pacing during acute right ventricular pressure overload

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