• F Mellert, P Lindner, W Schiller, E Gersing, I Heinze, J Kreuz, A Welz, and C J Preusse.
• Klinik und Poliklinik für Herzchirurgie, Universität Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany. fritz.mellert@uni-bonn.de
• Thorac Cardiovasc Surg. 2008 Aug 1;56(5):269-73.

BackgroundOptimizing atrioventricular (AV) delay improves cardiac output and postoperative outcome. Impedance cardiography (ICG) is a non-invasive method for CO measurement. This study evaluates the ability of two ICG methods to determine the optimal AV delay (OAVD) and to compare ICG with invasive PICCO measurements.MethodsIn 14 cardiosurgical ICU patients (age 70.4 +/- 12.0 yrs) with temporary pacing wires, OAVD was determined by pulse contour analysis (PICCO) and ICG (conventional ICG [CI] and electrical velocimetry [EV] ICG monitors). Cardiac output (CO) and stroke volume (SV) were measured during DDD pacing with AVD varying from 70 to 270 ms in 20-ms increments.ResultsMeasured OAV showed a linear correlation between PICCO and ICG: CI (r = 0.82, P < 0.0002) and EV (r = 0.84, P < 0.0002). The mean OAVD deviation between PICCO and ICG was 15.7 +/- 21.0 ms (CI) and 17.1 +/- 20.5 ms (EV). Hemodynamic parameters (SV increase OAVD against worst case) improved significantly (+ 11.7 +/- 7.2 %, P < 0.0001).ConclusionInappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.

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