The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function: A.

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Presentation transcript:

The effect of biventricular pacing on cardiac function after weaning from cardiopulmonary bypass in patients with reduced left ventricular function: A pressure– volume loop analysis Thorsten Hanke, MD, Martin Misfeld, MD, PhD, Matthias Heringlake, MD, Jan J. Schreuder, MD, Uwe K.H. Wiegand, MD, Frank Eberhardt, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 1, Pages 148-156 (July 2009) DOI: 10.1016/j.jtcvs.2009.02.010 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Segmental and global left ventricular pressure–volume loops during different pacing modes in representative patient. Segments of catheter are numbered from 1 (apex) to 6 (base) along longitudinal axis of catheter. Integrated volume of all segmental volumes constitutes total volume, which is represented in global pressure–volume loop. Apical segments are more distorted by right ventricular–based pacing (atrial synchronous right ventricular outflow tract pacing, DDD-RVOT) than by left ventricular–based pacing (atrial synchronous biventricular pacing, DDD-BIV, and atrial synchronous left ventricular pacing, DDD-LV) or by atrial-only pacing (AAI). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 148-156DOI: (10.1016/j.jtcvs.2009.02.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Individual patient data for maximum rate of positive left ventricular pressure change (+dP/dtmax) and end-systolic elastance (Ees). Overall responses to atrial synchronous biventricular pacing (DDD-BIV), atrial synchronous left ventricular pacing (DDD-LV), and atrial-only pacing (AAI) are superior to atrial synchronous right ventricular outflow tract pacing (DDD-RVOT). Dagger indicates P < .05. Lines indicate mean values. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 148-156DOI: (10.1016/j.jtcvs.2009.02.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Regression diagram showing difference (Δ) in stroke work (value for atrial synchronous biventricular pacing [DDD-BIV] minus value for atrial-only pacing [AAI]) plotted against PR interval during atrial-only pacing at 90 beats/min. Dotted lines represent 95% confidence interval. Patients with more stroke work in response to atrial-only pacing are plotted left of y-axis, whereas patients with higher stroke work in response to atrial synchronous biventricular pacing are plotted right of y-axis. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 148-156DOI: (10.1016/j.jtcvs.2009.02.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Alterations in dyssynchrony indices according to postoperative pacing mode. Systolic dyssynchrony is subdivided into early systole (Sys 1) and late systole (Sys 2). Diastole is subdivided into early (Dia 1) and late (Dia 2). Significant differences (P < .05) versus atrial synchronous right ventricular outflow tract pacing (DDD-RVOT) are marked with daggers. DDD-BIV, Atrial synchronous biventricular pacing; DDD-LV, atrial synchronous left ventricular pacing; AAI, atrial-only pacing. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 148-156DOI: (10.1016/j.jtcvs.2009.02.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Alterations in regional systolic dyssynchrony according to pacing mode. Systolic dyssynchrony decreases from apex to base. Significant difference (P < .0001) for apical versus mid and apical versus base for all pacing modes, mid versus base only significant (P = .01) for atrial synchronous right ventricular outflow tract pacing (DDD-RVOT). Significant differences versus atrial synchronous right ventricular outflow tract are marked with daggers (P < .05). DDD-BIV, Atrial synchronous biventricular pacing; DDD-LV, atrial synchronous left ventricular pacing; AAI, atrial-only pacing. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 148-156DOI: (10.1016/j.jtcvs.2009.02.010) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions