Hasan SUNAR, Ali FEDAKAR, Fuat BÜYÜKBAYRAK, Ahmet ŞAŞMAZEL, Onursal BUĞRA, Hasan ERDEM, Mehmet Mustafa CAN, Kürşat TİGEN, Ayşe BAYSAL

Precise placement of temporary pacing wire after coronary artery bypass grafting surgery: Is the left ventricle or right ventricle more convenient?

Amaç: Koroner arter bypass greftleme ameliyatı uygulanan ve ameliyat sonrası dönemde geçici kalp pili gereksinimi olan hastalarda kalp piline bağlı oluşan sol ventrikül asenkronisi değerlendirildi.Çalışma planı: Koroner arter bypass greftleme ameliyatı uygulanan ve ameliyat sonrası dönemde kalp pili gereksinimi olacağı düşünülen ardışık 18 hasta (13 erkek, 5 kadın; ort. yaş 62.0±15.0 yıl; dağılım 47-77 yıl) çalışmaya dahil edildi. Ameliyat sırasında hastaların tümüne sağ ventrikül (sağV) ve sol ventrikül (solV) epikardlarına geçici kalp pili telleri yerleştirildi. Epikardiyal teller sağV’de çıkım yoluna, solV’de apekse yerleştirildi. Ameliyat sonrası 5. günde ekokardiyografi (Vivid 7, Vingmed-General Electric Healthcare) ile bazal, sağV ve solV yerleştirilmesi sırasında doku Doppler ölçümleri yapıldı. SağV ve solV yerleştirilmesi sırasında kalp hızı kalp pili ile bazal değerin üzerine çıkartıldı. Analiz sırasında en az üç kardiyak siklus doku hız görüntüleme modunda kaydedildi. Kaydedilen görüntüler EchoPAC (EchoPAC 6.3, Vingmed-General Electric Healthcare) cihazı ile analiz edildi. Doku senkronizasyon görüntüleme için alınan görüntülerde, solV septal ve lateral segmentler işaretlendi ve septo-lateral gecikme olup olmadığı kaydedildi. Sonuçlar ortalama ± standart sapma olarak gösterildi ve ortalamaların karşılaştırılmasında Wilcoxon signed rank test kullanıldı.Bulgular: Hastaların tümünde sağV yerleştirilmesi sırasında septum ile lateral duvar arasında bazal değerlere oranla belirgin intraventriküler gecikme meydana geldi (52.9±20.7 ms’ye karşın 20.6±14.6 ms, p

Koroner arter bypass greftleme ameliyatı sonrası geçici telin en uygun yerleştirilmesi: Sol ventrikül mü yoksa sağ ventrikül mü daha uygundur?

Background: In this study, the left ventricular asynchrony of pacemakers in patients with possible need for a pacemaker in the postoperative period after coronary artery bypass grafting surgery was investigated.Methods: Eighteen consecutive patients (13 males, 5 females; mean age 66.2±12.4; range 47 to 77 years) undergoing coronary artery bypass grafting who were candidates for a pacemaker placement postoperatively were included in the study. Temporary epicardial pacing wires were intraoperatively placed both on the right ventricle (RV) and on the left ventricle (LV) in all patients. The epicardial wires were placed on the RV to the outflow tract and on the LV to the apex. On the fifth postoperative day echocardiography (Vivid 5, Vingmed, General Electric Healthcare) was performed and tissue Doppler measurements were taken during basal, RV pacing and LV pacing. During RV and LV pacing, the heart rate was increased above the basal rate. During the analysis, at least three cardiac cycles were recorded in the tissue velocity imaging mode. The recorded images were analyzed by EchoPAC (EchoPAC 6.3, Vingmed-General Electric Healthcare). In the images that were collected for tissue synchronization LV septal and lateral segments were marked and were subsequently analyzed for delay in the septo-lateral segment. The results were shown in mean ± standard deviation and statistical analysis was performed using the Wilcoxon signed rank test (p

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1) Bax JJ, Molhoek SG, van Erven L, Voogd PJ, Somer S, Boersma E, et al. Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2003;91:94-7.
2) Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, et al. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238-40.
3) Ghio S, Constantin C, Klersy C, Serio A, Fontana A, Campana C, et al. Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J 2004;25:571-8.
4) Heyndrickx GR, Vantrimpont PJ, Rousseau MF, Pouleur H. Effects of asynchrony on myocardial relaxation at rest and during exercise in conscious dogs. Am J Physiol 1988;254:817-22.
5) Unverferth DV, Magorien RD, Moeschberger ML, Baker PB, Fetters JK, Leier CV. Factors influencing the one-year mortality of dilated cardiomyopathy. Am J Cardiol 1984;54:147-52.
6) Bader H, Garrigue S, Lafitte S, Reuter S, Jaïs P, Haïssaguerre M, et al. Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 2004;43:248-56.
7) Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072-83.
8) Goldman BS, Hill TJ, Weisel RD, Scully HE, Mickleborough LL, Pym J, et al. Permanent cardiac pacing after open-heart surgery: acquired heart disease. Pacing Clin Electrophysiol 1984;7:367-71.
9) Gordon RS, Ivanov J, Cohen G, Ralph-Edwards AL. Permanent cardiac pacing after a cardiac operation: predicting the use of permanent pacemakers. Ann Thorac Surg 1998;66:1698-704.
10) Baerman JM, Kirsh MM, de Buitleir M, Hyatt L, Juni JE, Pitt B, et al. Natural history and determinants of conduction defects following coronary artery bypass surgery. Ann Thorac Surg 1987;44:150-3.
11) Lewis JW Jr, Webb CR, Pickard SD, Lehman J, Jacobsen G. The increased need for a permanent pacemaker after reoperative cardiac surgery. J Thorac Cardiovasc Surg 1998;116:74-81.
12) Park RC, Little WC, O’Rourke RA. Effect of alteration of left ventricular activation sequence on the left ventricular endsystolic pressure-volume relation in closed-chest dogs. Circ Res 1985;57:706-17.
13) Breithardt OA, Stellbrink C, Kramer AP, Sinha AM, Franke A, Salo R, et al. Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. J Am Coll Cardiol 2002;40:536-45.
14) Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288:3115-23.
15) Steinberg JS, Fischer A, Wang P, Schuger C, Daubert J, McNitt S, et al. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II. J Cardiovasc Electrophysiol 2005;16:359-65.
16) Prinzen FW, Augustijn CH, Arts T, Allessie MA, Reneman RS. Redistribution of myocardial fiber strain and blood flow by asynchronous activation. Am J Physiol 1990;259:H300-8.
17) Adomian GE, Beazell J. Myofibrillar disarray produced in normal hearts by chronic electrical pacing. Am Heart J 1986;112:79-83.
18) Tse HF, Lau CP. Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 1997;29:744-9.
19) Altın T, Karaoğuz R. Konvansiyonel sağ ventrikül apikal pacing: Olası zararlı etkileri ve bu etkilerin önlenmesi. MN kardiyoloji 2007;14:415-23.
20) Erdogan O, Altun A, Durmus-Altun G, Ozbay G. Inferolateral myocardial perfusion defect caused by right ventricular outflow tract pacing. Pacing Clin Electrophysiol 2004;27:808-11.
21) Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, et al. Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation 1997;96:3273-7.
22) Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567-73.