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Abstract
Standard postoperative dual-chamber pacing uses ventricular leads placed on the right
ventricle that produce dysynchronous ventricular activation and contraction. The hypothesis
that simultaneous stimulation of both ventricles by atrio-biventricular pacing improves
hemodynamic performance compared with that observed with standard atrio-monoventricular
pacing was tested in 18 patients 12 to 36 hours after elective coronary artery revascularization.
Temporary epicardial pacing electrodes were placed on the right atrium and into anterior
paraseptal sites on the right and left ventricle. Simultaneous biventricular activation
was documented by fusion morphology of surface electrocardiograms and by isochronal
epicardial activation mapping during biventricular pacing. Hemodynamic data were acquired
after 10 minutes of pacing at a fixed overdrive rate during atrial pacing and during
dual-chamber pacing using unipolar right ventricular, unipolar left ventricular, and
bipolar biventricular (left ventricular cathode) leads. Atrio-biventricular pacing
increased cardiac index and decreased systemic vascular resistance compared with atrial
pacing and with atrio-right ventricular and atrio-left ventricular dual-chamber pacing
(p < 0.05). These data support the use of atrio-biventricular pacing employing paraseptal
electrodes to optimize hemodynamic performance.