Resynchronization pacing is a useful adjunct to the management of acute heart failure after surgery for congenital heart defects

The acute hemodynamic effect of atrioventricular (AV) and inter/intraventri cular (IV) resynchronization accomplished by temporary pacing using multipl e epicardial pacing wires was evaluated in 20 children (aged 3.4 months to 14.0 years) after surgery for congenital heart defects Fulfilling the follo wing criteria: (1) presence of AV and/or IV conduction delay, and (2) need for inotropic support. AV resynchronization in = 13) was achieved by AV del ay optimization during atrial synchronous right ventricular outflow tract p acing. IV resynchronization (n = 14) wets accomplished by atrial synchronou s pacing from the right ventricular lateral wall in 7 patients with right b undle branch block and normal AV conduction and by atrial synchronous multi site ventricular pacing in another 7 patients with previously performed AV resynchronization. Compared with baseline values, AV resynchronization resu lted in an increase in arterial systolic, mean, and pulse pressures by 7.2 +/- 8.3% (p <0.01), 8.6 +/- 8.1% (p < 0.005), and 6.9 +/- 13.5% (p = NS), r espectively. IV resynchronization used either alone or added to previously performed AV resynchronization led to a pressure increase of 7.0 a 4.7%, 5. 9 +/- 4.7%, and 9.4 +/- 7.8%, respectively (p < 0.001 For oil). The combine d effect of AV and IV resynchronization resulted in a systolic, mean, and p ulse pressure increase of 10.2 +/- 5.0% (range 4.0 to 19.1), 8.6 +/- 5.4% ( range 0.8 to 14.8), and 15.2 +/- 8.5% (range 6.1 to 33.3), respectively (p < 0.001 for all). The increase in systolic arterial pressure after IV resyn chronization was positively correlated with the initial QRS duration (r = 0 .62, p < 0.05) and extent of QRS shortening (r = 0.66, p < 0.05). In conclu sion, resynchronization pacing led to a significant increase in arterial bl ood pressure and was a useful adjunct to the treatment of acute postoperati ve heart failure in patients with AV and/or IV conduction delay. (C) 2001 b y Excerpta Medica, Inc.