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Eur J Cardiothorac Surg 2006;29:633-634
© 2006 Elsevier Science NL

Letter to the Editor

Temporary left ventricular pacing after cardiac surgery

Angel L. Fernández a , * , José B. García-Bengochea a , Daniel Sánchez a , Julian Alvarez b

a Department of Cardiac Surgery, University Hospital, 15706 Santiago de Compostela, Spain
b Department of Anesthesiology, University Hospital, 15706 Santiago de Compostela, Spain

Received 25 August 2005; accepted 23 December 2005.

* Corresponding author. Tel.: +34 981 0950 212; fax: +34 981 950 227. (Email: alfg{at}secardiologia.es).

Key Words: Temporary pacing • Left ventricular pacing • Biventricular pacing

We read with great interest the article by Flynn et al. [1] which compared the potential benefits of left ventricular (LV) pacing versus the right ventricular (RV) pacing in the early postoperative period after open heart surgery.

Flynn et al. [1] describe three pacing modes with the same atrial pacing system: active and inactive (negative and positive) leads were placed upon the right atrium in a bipolar pacing configuration. RV pacing was performed using two leads (active and inactive) placed on the RV in a bipolar pacing configuration. LV pacing was realized by using the LV lead as the cathode (active) and a RV electrode as the anode (inactive). This LV arrangement is called split bipolar configuration [2,3]. Flynn et al. [1] consider that this configuration affords univentricular LV pacing. Surprisingly, other authors who have studied LV and biventricular pacing in surgical patients consider that this split bipolar configuration is a mode of biventricular pacing [4,5].

The aim of the study of Flynn et al. [1] was to assess the potential benefits of LV pacing in comparison to RV pacing. However, the mode of stimulation of the RV (bipolar) was different from the LV (split bipolar) and therefore the hemodynamic differences that they have observed may be related, at least in part, to different RV and LV pacing configurations.

From our point of view, Flynn et al. [1] could obtain LV pacing with their two LV leads by using one of them as a cathode (active) and the other as an anode (inactive) in a bipolar configuration. Reversing the polarity of LV wires is a simple method to change the site of LV activation.

Another possibility for LV stimulation could be placing two leads (active and inactive) immediately left to the mid left anterior descending coronary artery and two more leads (active and inactive) in the free LV wall. Anterior pacing of the LV could be obtained using one of the LV anterior wires as active electrode and the other as inactive electrode (bipolar configuration). LV posterior pacing could be obtained in a similar way using the LV posterior leads.

Different authors have used distinct terminology for the same cardiac pacing configuration. A clear and precise definition would be desirable.

References

  1. Flynn MJ, McComb JM, Dark JH. Temporary left ventricular pacing improves haemodynamic performance in patients requiring epicardial pacing post cardiac surgery. Eur J Cardiothorac Surg 2005;28:250-253.[Abstract/Free Full Text]
  2. Barold SS. What is cardiac resynchronization therapy?. Am J Med 2001;111:224-232.[CrossRef][Medline]
  3. Mayhew MW, Johnson PL, Slabaugh JE, Bubien RS, Kay GN. Electrical characteristics of a split cathodal pacing configuration. Pacing Clin Electrophysiol 2003;26:2264-2271.[CrossRef][Medline]
  4. Foster AH, Gold MR, McLaughlin JS. Acute hemodynamic effects of atrio-biventricular pacing in humans. Ann Thorac Surg 1995;59:294-300.[Abstract/Free Full Text]
  5. Weisse U, Isgro F, Werling Ch, Lehmann A, Saggau W. Impact of atrio-biventricular pacing to poor left-ventricular function after CABG. Thorac Cardiovasc Surg 2002;41:131-135.[CrossRef]




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