Acute hemodynamic effects of pacing in patients with fontan physiology: A prospective study

Brent J. Barber, Anjan S. Batra, Grant H. Burch, Irving Shen, Ross M. Ungerleider, John W. Brown, Mark W. Turrentine, Motomi Mori, Yi Ching Hsieh, Seshadri Balaji

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVES: The purpose of this research was to assess the hemodynamic response to atrial, ventricular, and dual-chamber pacing in patients with Fontan physiology. BACKGROUND: Bradycardia, due to sinus node dysfunction or atrioventricular (AV) block, with need for pacing, is common after the Fontan operation. The optimal pacing mode for Fontan patients is unknown, but is critical, as hemodynamic aberrancies may cause severe clinical deterioration. We hypothesized that AV synchrony is vital for maximizing Fontan hemodynamics. METHODS: A cross-over trial was conducted with 21 patients (age 2 to 18 years, median 4 years; male patients = 13) in the intensive care unit after a Fontan operation. Hemodynamic parameters, including mean left atrial pressure (LAP, in mm Hg), mean pulmonary artery pressure (PAP, in mm Hg), mean arterial blood pressure (MAP, in mm Hg), and indexed cardiac output via Fick (Qs, in l/min/m2) were measured with atrial, ventricular, and dual-chamber pacing. Measurements were made after pacing for 10 min in each mode, and a 10-min rest was given between each pacing maneuver. RESULTS: Asynchronous ventricular (VOO) pacing resulted in significantly worse hemodynamics when compared to dual-chamber (DOO) and atrial (AOO) pacing with a higher LAP (9.4 VOO; 6.8 DOO; 5.4 AOO) and PAP (15.2 VOO; 13.5 DOO; 12.7 AOO) and lower Qs (3.0 VOO; 3.5 DOO; 3.9 AOO) and MAP (60.1 VOO; 66.5 DOO; 67.2 AOO). CONCLUSIONS: Asynchronous ventricular pacing, after the Fontan procedure, has acute, adverse hemodynamic consequences (elevated LAP and PAP and decreased Qs and MAP).

Original languageEnglish (US)
Pages (from-to)1937-1942
Number of pages6
JournalJournal of the American College of Cardiology
Volume46
Issue number10
DOIs
StatePublished - Nov 15 2005

Fingerprint

Hemodynamics
Prospective Studies
Fontan Procedure
Arterial Pressure
Sick Sinus Syndrome
Atrial Pressure
Atrioventricular Block
Bradycardia
Cardiac Output
Cross-Over Studies
Pulmonary Artery
Intensive Care Units
Pressure
Research

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Acute hemodynamic effects of pacing in patients with fontan physiology : A prospective study. / Barber, Brent J.; Batra, Anjan S.; Burch, Grant H.; Shen, Irving; Ungerleider, Ross M.; Brown, John W.; Turrentine, Mark W.; Mori, Motomi; Hsieh, Yi Ching; Balaji, Seshadri.

In: Journal of the American College of Cardiology, Vol. 46, No. 10, 15.11.2005, p. 1937-1942.

Research output: Contribution to journalArticle

Barber, Brent J. ; Batra, Anjan S. ; Burch, Grant H. ; Shen, Irving ; Ungerleider, Ross M. ; Brown, John W. ; Turrentine, Mark W. ; Mori, Motomi ; Hsieh, Yi Ching ; Balaji, Seshadri. / Acute hemodynamic effects of pacing in patients with fontan physiology : A prospective study. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 10. pp. 1937-1942.
@article{73324bbc8a9240408247d37bf4cf68d6,
title = "Acute hemodynamic effects of pacing in patients with fontan physiology: A prospective study",
abstract = "OBJECTIVES: The purpose of this research was to assess the hemodynamic response to atrial, ventricular, and dual-chamber pacing in patients with Fontan physiology. BACKGROUND: Bradycardia, due to sinus node dysfunction or atrioventricular (AV) block, with need for pacing, is common after the Fontan operation. The optimal pacing mode for Fontan patients is unknown, but is critical, as hemodynamic aberrancies may cause severe clinical deterioration. We hypothesized that AV synchrony is vital for maximizing Fontan hemodynamics. METHODS: A cross-over trial was conducted with 21 patients (age 2 to 18 years, median 4 years; male patients = 13) in the intensive care unit after a Fontan operation. Hemodynamic parameters, including mean left atrial pressure (LAP, in mm Hg), mean pulmonary artery pressure (PAP, in mm Hg), mean arterial blood pressure (MAP, in mm Hg), and indexed cardiac output via Fick (Qs, in l/min/m2) were measured with atrial, ventricular, and dual-chamber pacing. Measurements were made after pacing for 10 min in each mode, and a 10-min rest was given between each pacing maneuver. RESULTS: Asynchronous ventricular (VOO) pacing resulted in significantly worse hemodynamics when compared to dual-chamber (DOO) and atrial (AOO) pacing with a higher LAP (9.4 VOO; 6.8 DOO; 5.4 AOO) and PAP (15.2 VOO; 13.5 DOO; 12.7 AOO) and lower Qs (3.0 VOO; 3.5 DOO; 3.9 AOO) and MAP (60.1 VOO; 66.5 DOO; 67.2 AOO). CONCLUSIONS: Asynchronous ventricular pacing, after the Fontan procedure, has acute, adverse hemodynamic consequences (elevated LAP and PAP and decreased Qs and MAP).",
author = "Barber, {Brent J.} and Batra, {Anjan S.} and Burch, {Grant H.} and Irving Shen and Ungerleider, {Ross M.} and Brown, {John W.} and Turrentine, {Mark W.} and Motomi Mori and Hsieh, {Yi Ching} and Seshadri Balaji",
year = "2005",
month = "11",
day = "15",
doi = "10.1016/j.jacc.2005.07.045",
language = "English (US)",
volume = "46",
pages = "1937--1942",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "10",

}

TY - JOUR

T1 - Acute hemodynamic effects of pacing in patients with fontan physiology

T2 - A prospective study

AU - Barber, Brent J.

AU - Batra, Anjan S.

AU - Burch, Grant H.

AU - Shen, Irving

AU - Ungerleider, Ross M.

AU - Brown, John W.

AU - Turrentine, Mark W.

AU - Mori, Motomi

AU - Hsieh, Yi Ching

AU - Balaji, Seshadri

PY - 2005/11/15

Y1 - 2005/11/15

N2 - OBJECTIVES: The purpose of this research was to assess the hemodynamic response to atrial, ventricular, and dual-chamber pacing in patients with Fontan physiology. BACKGROUND: Bradycardia, due to sinus node dysfunction or atrioventricular (AV) block, with need for pacing, is common after the Fontan operation. The optimal pacing mode for Fontan patients is unknown, but is critical, as hemodynamic aberrancies may cause severe clinical deterioration. We hypothesized that AV synchrony is vital for maximizing Fontan hemodynamics. METHODS: A cross-over trial was conducted with 21 patients (age 2 to 18 years, median 4 years; male patients = 13) in the intensive care unit after a Fontan operation. Hemodynamic parameters, including mean left atrial pressure (LAP, in mm Hg), mean pulmonary artery pressure (PAP, in mm Hg), mean arterial blood pressure (MAP, in mm Hg), and indexed cardiac output via Fick (Qs, in l/min/m2) were measured with atrial, ventricular, and dual-chamber pacing. Measurements were made after pacing for 10 min in each mode, and a 10-min rest was given between each pacing maneuver. RESULTS: Asynchronous ventricular (VOO) pacing resulted in significantly worse hemodynamics when compared to dual-chamber (DOO) and atrial (AOO) pacing with a higher LAP (9.4 VOO; 6.8 DOO; 5.4 AOO) and PAP (15.2 VOO; 13.5 DOO; 12.7 AOO) and lower Qs (3.0 VOO; 3.5 DOO; 3.9 AOO) and MAP (60.1 VOO; 66.5 DOO; 67.2 AOO). CONCLUSIONS: Asynchronous ventricular pacing, after the Fontan procedure, has acute, adverse hemodynamic consequences (elevated LAP and PAP and decreased Qs and MAP).

AB - OBJECTIVES: The purpose of this research was to assess the hemodynamic response to atrial, ventricular, and dual-chamber pacing in patients with Fontan physiology. BACKGROUND: Bradycardia, due to sinus node dysfunction or atrioventricular (AV) block, with need for pacing, is common after the Fontan operation. The optimal pacing mode for Fontan patients is unknown, but is critical, as hemodynamic aberrancies may cause severe clinical deterioration. We hypothesized that AV synchrony is vital for maximizing Fontan hemodynamics. METHODS: A cross-over trial was conducted with 21 patients (age 2 to 18 years, median 4 years; male patients = 13) in the intensive care unit after a Fontan operation. Hemodynamic parameters, including mean left atrial pressure (LAP, in mm Hg), mean pulmonary artery pressure (PAP, in mm Hg), mean arterial blood pressure (MAP, in mm Hg), and indexed cardiac output via Fick (Qs, in l/min/m2) were measured with atrial, ventricular, and dual-chamber pacing. Measurements were made after pacing for 10 min in each mode, and a 10-min rest was given between each pacing maneuver. RESULTS: Asynchronous ventricular (VOO) pacing resulted in significantly worse hemodynamics when compared to dual-chamber (DOO) and atrial (AOO) pacing with a higher LAP (9.4 VOO; 6.8 DOO; 5.4 AOO) and PAP (15.2 VOO; 13.5 DOO; 12.7 AOO) and lower Qs (3.0 VOO; 3.5 DOO; 3.9 AOO) and MAP (60.1 VOO; 66.5 DOO; 67.2 AOO). CONCLUSIONS: Asynchronous ventricular pacing, after the Fontan procedure, has acute, adverse hemodynamic consequences (elevated LAP and PAP and decreased Qs and MAP).

UR - http://www.scopus.com/inward/record.url?scp=27644524581&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=27644524581&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2005.07.045

DO - 10.1016/j.jacc.2005.07.045

M3 - Article

C2 - 16286183

AN - SCOPUS:27644524581

VL - 46

SP - 1937

EP - 1942

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 10

ER -