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Biventricular pacing concomitant to on-pump heart surgery: a case series
P G Golzio1, M Anselmino, C Comoglio
1Cardiology Unit, Department of Internal Medicine, University of Turin, Turin, Italy. pg.golzio@gmail.com
The Journal of Cardiovascular Surgery
|November 26, 2009
Summary
Biventricular epicardial pacing (BEP) during heart surgery is safe for severe heart failure (HF) patients, but high mortality and sudden deaths indicate further investigation into defibrillator use.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Severe heart failure (HF) presents significant challenges in cardiac surgery.
- Biventricular epicardial pacing (BEP) is explored as a potential intervention.
- Optimized pharmacologic therapy is standard for these patients.
Purpose of the Study:
- To report the authors' experience with biventricular epicardial pacing (BEP) as a primary procedure.
- To evaluate BEP in patients undergoing on-pump cardiac surgery for other indications.
- To assess the safety and efficacy of concomitant BEP in severe HF.
Main Methods:
- BEP was performed in 13 consecutive patients with stage IV HF.
- All patients had complete left bundle branch block and reduced ejection fraction (<30%).
- Procedures were concomitant to on-pump cardiac surgery.
Main Results:
- Effective BEP was achieved in all patients.
- Significant short-term improvements in functional, ECG, and echocardiographic parameters were observed.
- A high 6-month mortality rate (~70%) with numerous sudden cardiac deaths was noted.
Conclusions:
- Epicardial lead placement for BEP in severe HF patients undergoing cardiac surgery is safe and effective.
- Concomitant indications and lack of randomization limit evaluation of BEP's isolated effect.
- High sudden death rates suggest considering defibrillator implantation in this population.
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