Basic physiological studies on cardiac pacing with special reference to the optimal mode and rate after cardiac surgery

The Thoracic and Cardiovascular Surgeon
D BallerG Hellige

Abstract

Temporary cardiac pacing (CP) is frequently applied postoperatively in the management of low cardiac output (CO) and rhythm instability. However, uncertainty exists about the "optimal" pacing rate, range and mode due to incomplete information on myocardial oxygen consumption (MVO2), related to its hemodynamic determinants, and on myocardial pumping efficiency (eta) at CP. In 10 intact dogs atrial pacing (AP) (90 to 210 beats/min) and ventricular pacing (VP) (70 to 330 beats/min) were investigated in normal and failing hearts. AP and VP were compared at identical rates. MVO2 (4 to 20 ml/min . 100 gr) was measured directly according to the Fick principle. Cardiac efficiency was calculated as the ratio of oxygen equivalent of external cardiac work to MVO2. Rates with maximum CO and a maximal eta occurred only in heart failure. However, maximal CO and eta were obtained at different heart rates (HR). MVO2 was significantly higher (p less than 0.001) under VP as compared to AP at identical rates with a mean increase of 26.5% +/- 6% over AP, although hemodynamics were significantly lower under VP (p less than 0.001). Myocardial pumping efficiency was markedly better under AP with a mean increase of 63% +/- 4.5% over VP even in normal ...Continue Reading

Citations

Mar 1, 1990·The Journal of Clinical Investigation·F W Heineman, R S Balaban
May 1, 1990·Pacing and Clinical Electrophysiology : PACE·J L WessaleL A Geddes
Jan 6, 2005·The Journal of Thoracic and Cardiovascular Surgery·Henry M Spotnitz
Oct 24, 2006·International Journal of Cardiology·Zenon S KyriakidesTheofilos M Kolettis
May 1, 1988·Pacing and Clinical Electrophysiology : PACE·J L WessaleL A Grote
Aug 27, 2005·The Annals of Thoracic Surgery·George BerberianHenry M Spotnitz
Jan 30, 2002·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Oyvind ReitanHans Ohlin
Jul 1, 1989·Pacing and Clinical Electrophysiology : PACE·L F MoreiraA D Jatene
Apr 1, 1997·Pacing and Clinical Electrophysiology : PACE·G PayneJ D Skehan
Jan 1, 1987·Pacing and Clinical Electrophysiology : PACE·A WirtzfeldK Stangl

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