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Tex Heart Inst J. 2013;40(4):403-9.

Feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting in patients with reduced left ventricular function.

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Departments of Medicine (Dr. Wang), Surgery (Drs. Naka, Smith, H. Spotnitz, M. Spotnitz, and Stewart, and Mr. Cabreriza and Ms Kelly), Pediatrics (Dr. Richmond), and Biostatistics (Dr. Cheng), Columbia University, New York, NY 10032; and National Heart and Lung Institute (Dr. Quinn), Imperial College London, Harefield Heart Science Centre, Harefield UB9 6JH, United Kingdom.


In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting. The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15-0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in randomized order. Cardiac output with optimized biventricular pacing was 4.2 ± 0.7 L/min; in sinus rhythm, it was 3.8 ± 0.5 L/min. Atrial pacing at a matched heart rate resulted in cardiac output intermediate to that of sinus rhythm and biventricular pacing (4 ± 0.6 L/min). Optimization of atrioventricular and interventricular delay, in comparison with nominal settings, trended toward increased flow. This study shows that temporary biventricular pacing is feasible in patients with preoperative left ventricular dysfunction who are undergoing off-pump coronary artery bypass grafting. Further study of the possible clinical benefits of this intervention is warranted.


Arrhythmias, cardiac/therapy; cardiac output, low/therapy; cardiac pacing, artificial/methods; heart failure/therapy; stroke volume; ventricular dysfunction, left/complications/prevention & control

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