Load dependence of cardiac output in biventricular pacing: right ventricular pressure overload in pigs David G Rabkin, MD, Santos E Cabreriza, MBA, Lauren.

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Load dependence of cardiac output in biventricular pacing: right ventricular pressure overload in pigs David G Rabkin, MD, Santos E Cabreriza, MBA, Lauren J Curtis, BA, Sean P Mazer, MD, Josh P Kanter, MD, Alan D Weinberg, MS, Allan J Hordof, MD, Henry M Spotnitz, MD The Journal of Thoracic and Cardiovascular Surgery Volume 127, Issue 6, Pages 1713-1722 (June 2004) DOI: 10.1016/S0022-5223(03)01319-9

Figure 1 Schematic of biventricular pacing device. RA, Right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle. The proximal electrodes of an RA, bipolar epicardial pacing lead were split to the atrial sensing input of 2 different temporary external pacemakers. Similar leads were then attached to the RV and LV with the proximal electrodes inserted separately into the ventricular outputs of the pacemakers as demonstrated. In this way both devices receive the same atrial sensing signal and pace the RV and LV independently. In this example the effective AVD is 60 ms and the RLD is +40 ms (ie, RV is stimulated first). The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)

Figure 2 Representative data demonstrating electrocardiographic changes during changes in RLD from −80 ms to +80 ms in 20-ms increments. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)

Figure 3 Representative data demonstrating changes in hemodynamics during change in RLD from −60 ms to +60 ms in both the control state and during critical PS. Thick lines indicate the moment the RLD was changed from −60 ms to +60 ms. RVP, Right ventricular pressure; BP, blood pressure. PS is demonstrated by increased RVP and decreased cardiac output. In this example, cardiac output was 0.9 L/min during PS with a +60-ms RLD, 0.7 L/min during PS with a −60-ms RLD, and 1.4 L/min during the control state at both +60-ms and −60-ms RLD. Also note improvements in systemic arterial blood pressure during PS as the RLD is changed from −60 ms to +60 ms. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)

Figure 4 A, Effect of AVD on cardiac output with and without critical PS. These data are taken during simultaneous biventricular pacing (RLD = 0). Black squares represent controls and white squares represent PS. There is no treatment effect overall (P = .696), other than what existed at baseline (AVD = 60), that is, no interaction effect; the slopes of the 2 lines are similar. For each AVD the cardiac output during PS was significantly reduced (P < .01 Student t test) versus control. B, Effect of deviations from the optimal AVD on cardiac output. The AVD with the highest cardiac output was determined for each animal in each state and that AVD is labeled “optimum” on the abscissa. Cardiac outputs are averaged at AVD intervals of 30 ms before and after the optimum. Differences were not statistically significant. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)

Figure 5 A, Effect of RLD on cardiac output in the control state and during critical PS at animals' atrial sinus rate and while being paced at 100 beats/min. Black icons represent the control state; white icons, PS; squares, data collected during animals' atrial sinus rate; circles, during pacing at 100 beats/min. The RLD in milliseconds is represented on the abscissa and average cardiac output in L/min for all 5 AVDs on the ordinate. While animals are paced at their atrial sinus rate there is a statistically significant RLD-related change in cardiac output for PS (P = .0001, repeated-measures ANOVA) but not for the control state (P = .91). Standard errors are represented by brackets. Differences in cardiac output while paced at 100 beats/min were not statistically significant in either state. B, Effect of deviations from the optimal RLD on cardiac output during critical PS at the atrial sinus rate and while paced at 100 beats/min. White squares represent critical PS at atrial sinus rate; white circles represent critical PS while paced at 100 beats/min. Standard errors are represented by brackets. At both rates there are statistically significant differences in cardiac output as RLD is varied in 20-ms increments from the optimum (P < .0009 for atrial sinus rate, P < .0001 for paced at 100 beats/min, repeated-measures ANOVA). The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)

Figure 6 A, For each animal the AVD with an RLD of zero that yielded the highest cardiac output was determined. The cardiac outputs from +80- to −80-ms RLD at this AVD were averaged for each group during the control and PS states at the animals' sinus rate and during pacing at 100 beats/min. During PS at the animals' atrial sinus rate there was a statistically significant effect of RLD on cardiac output (P = .0001, repeated-measures ANOVA). B, Effect of deviations from the optimal RLD during critical PS on cardiac output after the optimal AVD has been established. White squares represent critical pulmonary stenosis at atrial sinus rate; white circles represent critical PS while paced at 100 beats/min. Standard errors are represented by brackets. At both rates there are statistically significant differences (P < .0001, repeated-measures ANOVA) in cardiac output as RLD is varied in 20-ms increments from the optimum. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1713-1722DOI: (10.1016/S0022-5223(03)01319-9)