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Feasibility of temporary biventricular pacing in patients with reduced left ventricular function after coronary
Frank Eberhardt1, Thorsten Hanke, Mathias Heringlake
1Medical Clinic II, Universitatsklinik Schleswig Holstein, Campus Luebeck, Leubeck, Germany. eberhard@uni-luebeck.de
Insights
Temporary biventricular pacing is a feasible and safe option for patients undergoing coronary artery bypass grafting (CABG) with reduced left ventricular (LV) function. This method supports hemodynamic stability post-surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Critical Care Medicine
Background:
- Patients with reduced left ventricular (LV) function undergoing coronary artery bypass grafting (CABG) often experience hemodynamic instability after cardiopulmonary bypass.
- Biventricular pacing has shown potential to improve hemodynamics in such cases.
Purpose of the Study:
- To assess the feasibility and safety of temporary biventricular pacing for 96 hours postoperatively in patients undergoing CABG.
- To evaluate pacing and sensing thresholds, lead survival, and pacemaker dysfunction incidence.
Main Methods:
- Fifty-one patients with reduced LV ejection fraction (mean 35%) undergoing CABG received temporary biventricular pacing.
- Unipolar epicardial wires were placed on the right atrium (RA), right ventricular (RV) outflow tract, and LV free wall.
- Pacing/sensing parameters and lead integrity were monitored for 96 hours post-operation.
Main Results:
- Pacing thresholds significantly increased for RA and RV by postoperative day 4.
- LV pacing thresholds showed a non-significant increase, while sensing thresholds decreased significantly for RV and LV.
- Overall lead failure incidence was 24% by day 4, with no significant difference between RV and LV leads.
- No ventricular proarrhythmia or pacemaker malfunction was observed.
Conclusions:
- Temporary biventricular pacing is a feasible and safe intervention for patients after CABG with impaired LV function.
- The use of a standard external pacing system for temporary biventricular pacing is well-tolerated.
Background And Methods:
Biventricular pacing improves hemodynamics after weaning from cardiopulmonary bypass in patients with severely reduced left ventricular (LV) function undergoing coronary artery bypass grafting (CABG). We examined the feasibility of temporary biventricular pacing for 96 hours postoperatively. Unipolar epicardial wires were placed on the roof of the right atrium (RA), the right ventricular (RV) outflow tract, and the LV free lateral wall and connected to an external pacing device in 51 patients (mean LV ejection fraction 35 +/- 4%). Pacing and sensing thresholds, lead survival and incidence of pacemaker dysfunction were determined.
Results:
Atrial and RV pacing thresholds increased significantly by the 4th postoperative day, from 1.6 +/- 0.2 to 2.5 +/- 0.3 V at 0.5 ms (P = 0.03) at the RA, 1.4 +/- 0.3 V to 2.7 +/- 0.4 mV (P = 0.01) at the RV, and 1.9 +/- 0.6 V to 2.9 +/- 0.7 mV (P = 0.3) at the LV, while sensing thresholds decreased from 2.0 +/- 0.2 to 1.7 +/- 0.2 mV (P = 0.18) at the RA, 7.2 +/- 0.8 to 5.1 +/- 0.7 mV (P = 0.05) at the RV, and 9.4 +/- 1.3 to 5.5 +/- 1.1 mV (P = 0.02) at the LV. The cumulative overall incidence of lead failure was 24% by the 4th postoperative day, and was similar at the RV and LV. We observed no ventricular proarrhythmia due to pacing or temporary pacemaker malfunction.
Conclusions:
Biventricular pacing after CABG using a standard external pacing system was feasible and safe.
