Biventricular Pacing during Cardiac Operations


  • Vincent A. Gaudiani
  • Luis J. Castro
  • Audrey L. Fisher



Background: Biventricular pacing (resynchronization therapy) improves the duration and quality of life in a subset of patients with congestive heart failure, but this technique has received little attention in the cardiac surgery literature. This report presents some preliminary ideas about its rationale and technique, and some likely indications for this procedure during the performance of cardiac operations.

Methods: We briefly summarize the theory and the results of the randomized clinical trials of resynchronization therapy that led us to consider biventricular pacing for high-risk cardiac surgery patients. We present some techniques for using temporary and permanent biventricular pacing in the operating room. We review the hospital records and present early results of the first 25 patients in whom we implanted permanent left ventricular free wall pacing electrodes with the intent of implanting biventricular pacing devices.

Conclusions: Biventricular pacing has great potential to simplify the management and improve the outcomes of some cardiac surgical patients.


Abraham WT, Fisher WG, Smith AL, et al. 2002. Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845-53.nBreithardt OA, Sinha AM, Schammenthal E, et al. 2003. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 41:765-70.nCazeau S, Leclercq C, Lavergne T, et al. 2001. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344:873-80.nFoster AH, Gold MR, McLaughlin JS. 1995. Acute hemodynamic effects of atrio-biventricular pacing in humans. Ann Thorac Surg 59:294-300.nKass D, Chen CH, Curry C, et al. 1999. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 99:1567-73.nKerwin WF, Botvinick EH, O'Connell JW, et al. 2000. Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony. JACC 35:1221-7.nLe Rest C, Couturier O, Turzo A, et al. 1999. Use of left ventricular pacing in heart failure: evaluation by gated blood pool imaging. J Nucl Cardiol 6:651-6.nPorciani MC, Puglisi A, Colella A, et al. 2000. Echocardiographic evaluation of the effect of biventricular pacing: the InSync Italian Registry.Eur Heart J 2(suppl J):J23-J30.nSaluhke TV, Francis DP, Sutton R. 2003. Comparison of medical therapy, pacing and defibrillation in heart failure (COMPANION) trial terminated early, combined biventricular pacemaker-defibrillators reduce all-cause mortality and hospitalization. Int J Cardiol 87:119-20.nSaxon LA, Kerwin WF, Calahan MK, et al. 1998. Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function. J Cardiovasc Electrophysiol 9:13-21.nWalker S, Levy T, Rex S, et al. 2000. Left ventricular remodeling with chronic biventricular pacing. Europace I(suppl D):abstract 212/5.nWeisse U, Isgro F, Werling C, et al. 2002. Impact of atrio-biventricular pacing to poor left-ventricular function after CABG. Thorac Cardiovasc Surg 41:131-5.nWilkoff BL, Cook JR, Epstein AE, et al. 2002. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 288:3115-23.n



How to Cite

Gaudiani, V. A., Castro, L. J., & Fisher, A. L. (2005). Biventricular Pacing during Cardiac Operations. The Heart Surgery Forum, 6(6), E126-E128.