Abstract 11635: Multisite Ventricular Pacing Using an Optimization Protocol in Postoperative Single Ventricle Patients
Ventricular dyssynchrony has been associated with patient morbidity and mortality following single ventricle (SV) palliation. Temporary multisite ventricular pacing (MSVP) may improve hemodynamics in these children. Our objective was to determine the feasibility of MSVP after SV palliation.
Methods: We assessed MSVP in the ICU in the first 24 hours after SV palliation. During surgery, two unipolar pacing leads were placed on the right atrium and four bipolar pacing leads were placed on standardized sites of the SV. Atrioventricular pacing was optimized for mean arterial pressure (MAP) using a protocol which tests, in random order: 1) 11 combinations of the four SV pacing sites, 2) 6 atrioventricular delays (50 to 150 msec) and 3) 14 intraventricular delays. In a final comparison, MAP was measured during the following, in random order: 1) optimized multisite bipolar pacing (BiP), 2) optimized multisite unipolar pacing (UniP), 3) optimized single-site pacing (AV), and 4) intrinsic rhythm (NoP). Each patient served as his/her own control. Linear mixed effects model was used for analysis.
Results: Seventeen pediatric patients were studied. Pacing increased MAP in all three configurations vs. NoP: 2.2% from 67.7 ± 2.4 (SEM) mmHg to 69.2 ± 2.5 (p=0.013) with BiP, 2.8% from 67.7 mmHg ± 2.4 to 69.6 ± 2.7 (p=0.002) with UniP, and 2.1% from 67.7 ± 2.4 to 69.1 ± 2.5 (p=0.020) with AV. Echocardiographic evaluation of fractional area change (FAC) in 9 patients revealed an increase with UniP vs. NoP from 32.0% ± 3.1 to 36.0% ± 4.2 (p=0.024). FAC during MSVP and AV was not significantly different from NoP. There were no study related adverse events.
Conclusion: This is the first study of MSVP optimization in children in the early postoperative period following SV palliation. Results confirm feasibility and safety of bedside optimization, with an increase in MAP and FAC. A larger, randomized trial is necessary to determine whether this hemodynamic improvement results in clinical benefit.
- © 2012 by American Heart Association, Inc.