Optimized perioperative biventricular pacing in setting of right heart failure

Aims: A 78-year-old female with prior atrioventricular junctional ablation for paroxysmal atrial fibrillation and implantation of DDDR pacemaker underwent repair of severe tricuspid insufficiency. Effects of biventricular pacing were tested with temporary wires at the conclusion of cardiopulmonary bypass. Methods: An ultrasonic flow probe was placed on the ascending aorta for real time cardiac output measurements. Atrioventricular delay optimization was performed and biventricular pacing was initiated while right-left ventricular delays were varied. Results: There was no advantage of biventricular pacing (optimum right-left ventricular delay of +80 ms) compared with existing DDD. Conclusions: This study confirms the physiological effects of right-left ventricular delay on cardiac output after cardiopulmonary bypass.