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CLINICAL RESEARCH: CONGENITAL HEART DISEASE AND RESYNCHRONIZATION

Impact of Conventional Versus Biventricular Pacing on Hemodynamics and Tissue Doppler Imaging Indexes of Resynchronization Postoperatively in Children With Congenital Heart Disease

Oregon Health and Science University, Portland, Oregon

Manuscript received April 18, 2005; revised manuscript received August 16, 2005, accepted August 19, 2005.

^_* Reprint requests and correspondence: Dr. David J. Sahn, L608, Pediatric Cardiology, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098 (Email: sahnd{at}ohsu.edu).

OBJECTIVES: We sought to evaluate the effects of biventricular (BDOO) pacing compared with conventional (CDOO) atrioventricular (AV) sequential and atrial (AOO) pacing in children and infants in the early postoperative period after open heart surgery for congenital heart disease (CHD).

BACKGROUND: Biventricular pacing using right ventricular (RV) and left ventricular (LV) leads can improve hemodynamics in patients with CHD, but it is unclear whether this occurs in early postoperative children with CHD.

METHODS: Nineteen children (age, 5 days to 5.4 years; median, 5.5 months) with a definitive biventricular repair for CHD underwent AOO, CDOO, and BDOO pacing with temporary epicardial leads for 10 min each. The AV delay was 80% of the PR interval for the CDOO and BDOO modes. Lead placement was two right atrial, two RV, and one LV. Blood samples for cardiac index (arterial and venous) and tissue Doppler (TDI) traces were obtained in each pacing mode with a Vivid 7 BT04 digital ultrasound system (GE/VingMed, Horten, Norway) from an apical four-chamber view and analyzed with EchoPac software.

RESULTS: The QRS duration was significantly shorter for BDOO compared with CDOO, and the cardiac index was higher with BDOO compared with CDOO. Systemic blood pressure was not different between the three modes of pacing (AOO, CDOO, BDOO). The TDI-derived strain rate showed minimal dyssynchrony in AOO as seen by isovolumic tensing (IVT) and peak systolic contraction (PSC) timing differences between RV and LV. The CDOO worsened dyssynchrony with prolonged IVT and PSC. The BDOO showed improved synchrony as seen by IVT and PSC.

CONCLUSIONS: The TDI-derived strain rate showed worsened ventricular dyssynchrony with CDOO and improvement with BDOO. Cardiac index and QRS duration were improved by BDOO compared with CDOO. This suggests that short-term pacing with BDOO may benefit children with CHD needing pacing in the postoperative period.

Abbreviations and Acronyms   AOO = atrial pacing   BDOO = biventricular pacing   CDOO = conventional dual-chamber pacing   CHD = congenital heart defect   CRT = cardiac resynchronization therapy   IVT = isovolumic tensing   LV = left ventricle/ventricular   PSC = peak systolic contraction   RBBB = right bundle branch block   RV = right ventricle/ventricular   TDI = tissue Doppler imaging

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