Effect of atrioventricular conduction prolongation on optimization of paced atrioventricular delay for biventricular

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Alexander Rusanov1, Daniel Y Wang, Santos E Cabreriza

  • 1Department of Anesthesiology, Columbia University Medical Center, New York, NY 10032, USA. ar2765@columbia.edu

Journal of Cardiothoracic and Vascular Anesthesia
|October 18, 2011
PubMed

Insights

Atrioventricular conduction prolongation (AVCP) varies significantly after cardiac surgery, impacting optimal biventricular pacing (BiVP) settings. Adjusting for AVCP is crucial for effective BiVP and improved patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Atrioventricular conduction prolongation (AVCP) is a measurable consequence of cardiac pacing, primarily due to delayed atrial conduction.
  • Noninvasive methods for assessing atrial conduction are limited, necessitating indirect measures.
  • AVCP can serve as a surrogate marker for atrial conduction status.

Purpose of the Study:

  • To utilize AVCP as an estimate of atrial conduction.
  • To investigate the relationship between AVCP and optimal paced atrioventricular delay (pAVD).
  • To evaluate the impact of AVCP on hemodynamic optimization during biventricular pacing (BiVP).

Main Methods:

  • Retrospective analysis of data from a randomized controlled study.
  • Inclusion of cardiac surgical patients undergoing temporary BiVP post-cardiopulmonary bypass.
  • Optimization of BiVP parameters while maintaining stable hemodynamic support.

Main Results:

  • AVCP exhibited significant variability (mean ± SD: 64 ± 28 ms) in patients after cardiopulmonary bypass.
  • Patients with longer AVCP demonstrated significantly higher optimal cardiac output (OptCO) and mean arterial pressure (OptMAP).
  • Inappropriately short pAVD selection in short-AVCP patients led to suboptimal hemodynamic performance.

Conclusions:

  • AVCP is a critical factor influencing the determination of optimal pAVD during BiVP.
  • Failure to account for individual AVCP can lead to the selection of suboptimal pAVDs.
  • This can result in ineffective BiVP and potentially deleterious hemodynamic consequences, particularly with standard pAVD settings.
Abstract

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