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Ventricular resynchronization by multisite pacing improves myocardial performance in the postoperative
Emile A Bacha1, Frank J Zimmerman, Victor Mor-Avi
1Cardiothoracic Surgery, Congenital and Pediatric Cardiac Surgery, The University of Chicago Hospitals, Chicago, Illinois 60637, USA. ebacha@surgery.bsd.uchicago.edu
The Annals of Thoracic Surgery
|October 30, 2004
Summary
Multisite pacing significantly improves cardiac performance in single-ventricle patients post-surgery. This technique enhances ventricular contraction synchrony, as confirmed by real-time 3D echocardiography.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Echocardiography
Background:
- Multisite pacing (MSP) acutely improves myocardial performance in heart failure, but mechanisms remain unclear.
- The study investigates MSP's effect on myocardial performance in postoperative single-ventricle (SV) patients.
- It aims to elucidate the mechanism by assessing ventricular contraction synchrony using 3D echocardiography.
Purpose of the Study:
- To determine if multisite pacing acutely improves myocardial performance in postoperative single-ventricle patients.
- To elucidate the mechanism of improvement by assessing ventricular contraction synchrony.
Main Methods:
- 26 single-ventricle patients (mean age 28 months) undergoing various palliative procedures were studied.
- Electrocardiogram, blood pressure, oxygen saturation, and 3D echocardiograms were recorded at baseline and during MSP.
- Regional ventricular contraction synchrony was assessed using 3D echocardiography and an index of asynchrony.
Main Results:
- MSP decreased QRS duration (93.9 to 71.7 ms) and increased systolic blood pressure (86.3 to 93.8 mm Hg) and cardiac index (3.2 to 3.7 L x min(-1) x m(-2)).
- The index of asynchrony improved in 80% of patients (10.3 to 6.0).
- These improvements were observed median 2 days postoperatively.
Conclusions:
- Multisite pacing demonstrates efficacy in improving cardiac performance following single-ventricle palliation.
- Real-time 3D echocardiography confirmed that MSP enhances ventricular contraction synchrony.