• Z Vichova, R Hénaine, and M C Basto Duarte.
• Service d'anesthésie réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, 28 avenue du Doyen-Lépine, Lyon-Bron, Lyon, France.
• Ann Fr Anesth Reanim. 2011 May 1;30(5):403-9.

ObjectivesThe aims of this study were to test the hypotheses that in the postoperative period following corrective surgery for congenital heart defects: (i) atrio-right ventricular (RA-RV) pacing decreases cardiac output (CO) compared with right atrial (RA) pacing, (ii) atrio-biventricular (RA-BiV) and left ventricular (RA-LV) pacing improves CO compared with RA-RV pacing.Study DesignProspective observational study.PatientsChildren 0-2years of age referred for surgery of congenital heart defects were studied during intrinsic rhythm and atrial, atrio-right ventricular, atrio-left ventricular and atrio-biventricular pacing. CO, extrapolated from mean systolic aortic velocity (MSAV), and left ventricular dyssynchrony were assessed using transthoracic echocardiography.ResultsRA-RV pacing induced a significant decrease in CO (MSAV 0.52±0.19m/s to 0.46±0.16m/s, p=0.01) and a significant increase in LV dyssynchrony (8.7±7.9ms to 33±21ms, p=0.001). RA-BiV pacing induced a significant increase in CO (MSAV 0.46±0.16m/s to 0.52±0.18m/s, p=0.01) and a significant decrease in LV dyssynchrony (33±21ms to 7±4ms, p=0.0003) compared with RA-RV pacing. RA-LV pacing induced a significant decrease in LV dyssynchrony (33±21ms to 9±7ms, p=0.0007) without a significant improvement of CO compared with RA-RV pacing.ConclusionsRA-BiV pacing improves CO compared with RA-RV pacing in the early postoperative period following pediatric cardiac surgery. This improvement is related to a reduction in left ventricular dyssynchrony.Copyright © 2011. Published by Elsevier SAS.

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