scholarly journals The effect of biventricular pacing on cardiac function after open heart surgery

2019 ◽  
Vol 1 (3) ◽  
pp. 85-90
Author(s):  
Mohamed Ebrahim ◽  
Mohamed Shafik Mohran ◽  
Ayman Abd Elkhalek Sallam ◽  
Abd Elhady Mohamed Taha
Keyword(s):  
Cardiac Output ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Wall Motion ◽  
Biventricular Pacing ◽  
P Value ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Rv Pacing ◽  
The Right

Background: Temporary postoperative pacing could enhance recovery of the cardiac function. The right ventricular pacing (RV) is commonly used, but it can cause dyssynchronous contraction of both ventricles. Biventricular pacing (BV) could improve the systolic function by synchronizing the ventricular contraction. The aim of this study is to evaluate the effectiveness of biventricular pacing in improving the hemodynamics in the early postoperative period compared to other pacing modes. Methods: This is a clinical crossover trial including 50 patients who underwent open cardiac surgery in the period from September 2017 to September 2018. Mean age was 46.78± 12.09 years, and 50% were males. Temporary pacing leads were attached to the anterior wall of the right ventricle 1-2 cm paraseptally and the lateral wall of left ventricle 1-2 cm paraseptally. Each patient was paced for 3 minutes in the first 1-4 postoperative hours with 20 minutes washout period between different pacing modes. Study endpoints included cardiac output, ejection fraction (EF) and wall motion abnormality. Results: Biventricular and right ventricular pacing increased postoperative cardiac output (6.31± 1.28 and 5.2±0.72 L/min; respectively), but BV pacing was superior to RV pacing (P-value <0.001). The effect of BV pacing was more evident in patients with EF < 50% (7.27± 0.895 vs. 5.26 ± 0.634 L/min; p< 0.001). The postoperative EF improved during BV pacing (53.16± 4.71%) compared to RV pacing (49.4± 4.07%; P-value <0.001). Both BV and RV pacing were associated with less paradoxical septal wall motion abnormality (P-value <0.001). Conclusions: Temporary postoperative biventricular pacing improves hemodynamics compared to right ventricular and no pacing. Routine BV pacing is recommended especially in patients with low ejection fraction.

scholarly journals P335 Evaluation of systolic right ventricular function with 3D echocardiography in patients with isolated right ventricular pacing induced left ventricle dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Jenei ◽  
R Kadar ◽  
M Clemens ◽  
Z Csanadi
Keyword(s):  
Ejection Fraction ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Right Ventricular Pacing ◽  
Lv Dysfunction ◽  
Rv Pacing ◽  
The Mean ◽  
Dimensional Echocardiography ◽  
The Right

Abstract Background Right ventricular (RV) pacing may worsen left ventricular (LV) systolic function causing heart failure, but the exact mechanism of the LV dysfunction is unknown. The purpose of this study was to examine the right ventricle by three-dimensional echocardiography in patients with LV dysfunction accompanied by long-term RV pacing. Methods We analysed consecutive patients receiving permanent pacemaker (PPM) due to atrioventricular block from 2015 January to 2017 March (n = 335). During the mean follow-up period (27 months) 4 patients were selected with at least 5% decrease in the LV ejection fraction measured by two-dimensional echocardiography (B group). Control (K) group contains 4 age-, sex-, concomitant disease matched patients without the sign of LV dysfunction from the same time interval. Right ventricle function was assessed by 3D echocardiography. Results In both groups, there were 3 men, and the mean age was similar (B: 68 ± 6 y vs. K: 66 ± 10 y; p = 0.65). Right ventricular ejection fraction (EF) was significantly higher in controls compared to patients (K: 49 ± 7.8% vs. B: 36 ± 3.1%; p = 0.02), while the right ventricular volumes [end-systolic (K: 79 ± 47 ml vs. B: 71 ± 7 ml; p = 0.77), end-diastolic (K: 151 ± 73 ml vs. B: 111 ± 11 ml; p = 0.36) and stroke volumes (K: 58 ± 44 ml vs. B: 40 ± 6 ml; p = 0.5)] did not differ significantly. We did not find any important differences between the groups regarding the permanent right ventricle pace rate (K: 93 ± 5.6% vs. B: 84 ± 19.5%; p = 0.5), systolic pulmonary pressure (K: 34 ± 6 mmHg vs. B: 35 ± 18 mmHg; p = 0.92), or the severity of tricuspid regurgitation. Conclusion The left ventricular dysfunction after permanent right ventricular pacing results in right ventricular systolic dysfunction. The decrease of RV ejection fraction is not associated with RV enlargement or increase of pulmonary pressure.

scholarly journals Biventricular Pacing Decreases Sympathetic Activity Compared With Right Ventricular Pacing in Patients With Depressed Ejection Fraction

Circulation ◽  
2000 ◽  
Vol 102 (9) ◽  
pp. 1027-1032 ◽  
Author(s):  
Mohamed H. Hamdan ◽  
Jason D. Zagrodzky ◽  
Jose A. Joglar ◽  
Clifford J. Sheehan ◽  
Karthik Ramaswamy ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Sympathetic Activity ◽  
Biventricular Pacing ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing

scholarly journals P410Pacing from his bundle area in patients with severe conduction disease and high burden of the right ventricular pacing

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i76-i76
Author(s):  
K Curila ◽  
D Herman ◽  
P Stros ◽  
J Zdarska ◽  
R Prochazkova ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
High Burden ◽  
His Bundle ◽  
The Right

scholarly journals 176Chronic apical and non-apical right ventricular pacing in patients with high-grade atrioventricular block: results of the right pace study

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii15-iii15
Author(s):  
C. Muto ◽  
V. Calvi ◽  
GL. Botto ◽  
D. Pecora ◽  
D. Porcelli ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Atrioventricular Block ◽  
High Grade ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
The Right

RV pacing during orthodromic AVRT

2017 ◽  
Author(s):  
Hein Heidbuchel ◽  
Mattias Duytschaever ◽  
Haran Burri
Keyword(s):  
Right Ventricular ◽  
Left Bundle Branch Block ◽  
Ventricular Pacing ◽  
Bundle Branch Block ◽  
Right Ventricular Pacing ◽  
Rv Pacing

This case presents entrainment of orthodromic atrioventricular re-entrant tachycardia by right ventricular pacing in the presence of left bundle branch block

43Dynamic atrioventricular delay achieves superior electrical synchrony when pacing both ventricles rather than left ventricle alone

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Thibault ◽  
A Chow ◽  
J Mangual ◽  
N Badie ◽  
P Waddingham ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Atrioventricular Delay ◽  
Intrinsic Conduction ◽  
Left Ventricular Pacing ◽  
Additional Reference ◽  
The Right

Abstract Funding Acknowledgements Abbott Introduction Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization when pacing one or two sites in the left ventricle together with the right ventricle. However, it is unknown if the same benefit can be gained by using SyncAV while pacing only the left ventricle without right ventricular pacing. Purpose   Evaluate the acute improvement in electrical synchrony provided by SyncAV with and without MultiPoint Pacing (MPP) during biventricular (BiV) and LV only pacing. Methods   Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. QRSd was measured post-implant from 12-lead surface electrograms by blinded experts during the following pacing configurations: intrinsic conduction, conventional BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each pacing mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. As an additional reference, QRSd during BiV was also measured using the nominal static AVD (paced/sensed AVD = 140/110 ms). BiV and LVSS pacing used the latest activating LV cathode, whereas MPP and LVMPP used the two LV cathodes with the widest possible separation (&gt;30mm). All configurations used the minimum programmable RV-LV and LV1-LV2 delays. Results   Thirty-five patients (78% male, 33% ischemic, 26% ejection fraction, 165 ms intrinsic QRSd) completed device implant and QRSd assessment. Relative to intrinsic conduction, BiV with nominal AVD reduced the QRSd by 17.5% (p &lt; 0.001 vs intrinsic). Enabling SyncAV with a patient-optimized offset significantly improved QRSd reduction. BiV + SyncAV reduced QRSd by 25.2% (p &lt; 0.001 vs. BiV). The greatest QRSd reduction of 28.9% was achieved by MPP + SyncAV (p &lt; 0.01 vs. BiV + SyncAV). Single- and multi-site LV-only pacing reduced QRSd significantly less than corresponding biventricular modes. LVSS + SyncAV reduced QRSd by 22.5% (p &lt; 0.05 vs. BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 24.3% (p &lt; 0.05 vs. MPP + SyncAV). As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV (median: 13%, mean: 17%) vs. MPP + SyncAV (median: 13%, mean 16%, p = 0.35 vs. BiV + SyncAV), and similar for LVSS + SyncAV (median: 20%, mean: 28%) and LVMPP + SyncAV (median: 23%, mean: 26%, p = 0.35 vs. LVSS + SyncAV), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p &lt; 0.01 for both pairs). Conclusion: Greater improvement in electrical synchrony using SyncAV was observed when right ventricular pacing was included with left ventricular pacing. Additional benefit was gained by the addition of a second left ventricular pacing site with MPP in combination with SyncAV in both biventricular and LV only pacing modes. Abstract Figure.

scholarly journals Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Carmine Muto ◽  
Valeria Calvi ◽  
Giovanni Luca Botto ◽  
Domenico Pecora ◽  
Daniele Porcelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
X Rays ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Right Ventricular Pacing ◽  
The Right

Objective. The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing. Background. Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers. Methods. The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing. Results. RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th–75th percentiles, 13–25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p=0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p=0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p=0.402) and secondary (p=0.941) outcome. Conclusions. In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).

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