Intraoperative rhythm analysis using pulmonary venous Doppler: importance of atrioventricular interval

Inappropriate timing or duration of the atrioventricular (AV) interval with DDD pacing can lead to hemodynamic compromise. Intraoperative pulmonary venous Doppler interrogation by transesophageal echocardiography can be a valuable tool to assess subtle rhythm abnormalities that may go unnoticed by electrocardiogram and hemodynamic monitoring. We describe a dramatic example of hemodynamic improvement following pacemaker adjustment after pulmonary venous Doppler identified an inappropriately short AV interval.