Lowest peak central venous pressure correlates with highest invasive arterial blood pressure as a method for optimising AV delay in post-surgical temporary pacing

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation. Background Atrioventricular (AV) delay optimisation has been performed using a variety of methods, including doppler outflow and alternating blood pressure algorithms. Patients after cardiac surgery are usually invasively monitored with arterial and central venous pressure (CVP) lines. Purpose We aimed to see if the CVP line could be used to optimise AV delays in temporary pacing for situations where the arterial line is absent or non-functional. Methods 11 patients in sinus rhythm but with temporary pacemakers after cardiac surgery were studied. Each patient underwent alternating optimisation algorithms where they were subjected to 8 transitions between a reference AV delay of 120ms and a tested AV delay ranging from 40ms to 280 ms. Testing was terminated after the AV delay occurred when native conduction occurred i.e after they began AAI pacing. All patients were paced at 80 bpm. Arterial blood pressure (ABP) and CVP were recorded from radial arterial lines and central venous lines in the internal jugular vein during the transitions. The optimal point was defined as the AV delay generating the maximum systolic blood pressure. The CVP was measured in 3 ways: peak pressure, mean pressure, and area under the curve. Central venous pressure tracings were corrected for respiration using a "fit-a-curve" function. All analysis was performed in Python. Results Individual pressure readings. There was a negative correlation between individual ABP and Peak CVP pressure readings (R= -0.539, p=0<0.001). A representative example for a single patient is shown in Figure 1 and for all data in Figure 2. A similar relationship, albeit less strong, was seen between ABP and Mean CVP (R= -0.281, p=0.046). There was no significant relationship between ABP and CVP AUC (R = -0.281, p=0.130). Optimum pressure settings: There was a strong correlation between the optimum AV delay as defined by the highest ABP and the optimum AVD as defined by the lowest peak CVP (R = 0.672, p=0.03). There was no significant relationship between the optimum AVD delay as defined by peak ABP and the optimum AVD defined by either mean CVP nor CVP AUC (R=0.269, p=0.452 for both). Conclusions There is an inverse relationship between individual measurements of arterial blood pressure and both peak and mean central venous pressure. The optimal AVD as defined by the highest ABP correlates with the optimal AVD as defined by the lowest peak CVP measurement. However, this method does require correction for respiratory artefact.