The effect of biventricular pacing after coronary artery bypass grafting: A prospective randomized trial of different pacing modes in patients with reduced left ventricular function

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 137; no. 6; pp. 1461 - 1467
• Main Authors: Eberhardt, Frank, MD, Heringlake, Matthias, MD, Massalme, Maximilian S., MD, Dyllus, Anika, MD, Misfeld, Martin, MD, PhD, Sievers, Hans-H., MD, Wiegand, Uwe K.H., MD, Hanke, Thorsten, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2009; AATS/WTSA; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias, Cardiac - therapy; Biological and medical sciences; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass; Coronary heart disease; Female; Heart; Hemodynamics; Humans; Kidney - physiopathology; Male; Medical sciences; Pneumology; Stroke Volume; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; NT-pro-BNP; 22; 23; atrioventricular synchronous biventricular pacing; ejection fraction; RV; atrioventricular synchronous pacing at right ventricular outflow tract; VVI; LV; RIFLE; aminoterminal pro-brain natriuretic peptide; GFR; cardiopulmonary bypass; risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal failure; left ventricular; coronary artery bypass grafting; EF; DDD-BIV; right ventricular; glomerular filtration rate; AAI; DDD-RVOT; CPB; atrial inhibited pacing; CABG; ventricular-only demand pacing; Human; Instrumentation therapy; Cardiovascular disease; Patient; Coronary heart disease; Prospective; Instrumental stimulation; Randomization; Coronary artery bypass; Anesthesia; Graft; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2008.11.025

Objectives Biventricular pacing acutely improves left ventricular function in patients with heart failure and left ventricular dyssynchrony. Pressure-volume loop analysis has shown acute perioperative hemodynamic benefits of biventricular pacing immediately after weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting, but whether these effects can be maintained for the early postoperative period is unclear. We hypothesized that biventricular pacing is superior to atrioventricular universal pacing at right ventricular outflowtract and atrial inhibited pacing in patients undergoing coronary artery bypass grafting. Methods Ninety-four patients (mean age, 67 ± 9 years; mean ejection fraction, 35% ± 4%) were prospectively randomized to undergo biventricular, atrioventricular universal, or atrial inhibited pacing at 90 beats/min for 96 postoperative hours. Clinical end points and postoperative hemodynamics, aminoterminal pro–brain natriuretic peptide, inotropic support, atrial fibrillation, ventricular arrhythmias, and renal function were evaluated. Results Diastolic pulmonary arterial pressure, mean arterial pressure, mixed venous saturation, cardiac index, and cardiac power index did not differ significantly among groups for all time points. Neither raw aminoterminal pro–brain natriuretic peptide nor differential from preoperative values differed significantly among groups at any time point. Median intensive care unit stay (19.5 hours) did not differ significantly by pacing mode. Incidences of postoperative atrial fibrillation were 40% for atrial inhibited, 29% for atrioventricular universal, and 37% for biventricular (differences not significant). Renal function was unaffected by pacing mode. Conclusion Despite short-term hemodynamic benefits for patients with reduced left ventricular function, biventricular pacing did not lead to improved postoperative hemodynamics or clinical outcome.