Hemodynamically optimized temporary cardiac pacing after surgery for congenital heart defects

Disturbance of normal AV synchrony and dyssynchronous ventricular contracti on map be deleterious in patients with otherwise compromised hemodynamics. This study evaluated the effect of hemodynamically optimized temporary dual chamber pacing in patients after surgery for congenital heart disease. Pac ing was performed in 23 children aged 5 days to 7.7 years (median 7.3 month s) with various postoperative dysrhythmias, low cardiac output, and/or high inotropic support and optimized to achieve the highest systolic and mean a rterial pressures. The following four pacing modes rr ere used: (1) AV sync hronous or AV sequential pacing with individually optimized AV delay in 11 patients with first to third-degree Ali block; (2) Air sequential pacing us ing transesophageal atrial pacing in combination with a temporary DDD pacem aker for atrial tracking and ventricular pacing in three patients with thir d-degree AV block and junctional ectopic tachycardia, respectively, who had poor signal and exit block on atrial epicardial pacing wires; (3) R wave s ynchronized atrial pacing in eight patients with junctional ectopic tachyca rdia and impaired antegrade AV conduction precluding the use of atrial over drive pacing; (4) Atrio-biventricular sequential pacing in two patients. Pr essures measured during optimized pacing were compared to baseline values a t underlying rhythm (13 patients with first-degree AV block or junctional e ctopic tachycardia) or during pacing modes commonly used in the given clini cal situation: AAI pacing (1 patient with slow junctional rhythm and first- degree AV block during a trial pacing), VVI pacing (2 patients with third-d egree AV block and exit block and poor sensing on epicardial atrial pacing wires) and dual-chamber pacing with AV delays set to 100 ms (atrial trackin g) or 150 ms (AV sequential pacing) in 7 patients with second- to third-deg ree AV block and functional atrial pacing wires. Optimized pacing led to a significant increase in arterial systolic (mean) pressure from 71.5 +/- 12. 5 (52.3 +/- 9.0) to 80.5 +/- 12.2 (59.7 +/- 9.1) mmHg (P < 0.001 for both) and a decrease in central venous (left atrial) pressure from 12.3 +/- 3.4 ( 10.5 +/- 3.2) to 11.0 +/- 3.0 (9.2 +/- 2.7) mmHg (P < 0.001 and < 0.005, re spectively. In conclusion, several techniques of individually optimized tem porary dual chamber pacing leading to optimal AV synchrony and/or synchrono us ventricular contraction were successfully used to improve hemodynamics i n patients with heart failure and selected dysrhythmias after congenital he art surgery.