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Abstract
Biventricular pacing has been suggested in end-stage heart failure. We present a 59-year-old patient undergoing second re-do CABG (coronary artery bypass graft) and carotid artery endarterectomy. Ejection fraction was 15%, QRS-width 175 ms. Following the carotid and CABG procedure, an implanted single-chamber ICD (implantable cardioverter defibrillator) was upgraded to permanent biventricular DDD pacing by implantation of one epicardial left ventricular and one epicardial atrial electrode. At follow-up two months postoperatively ejection fraction had significantly improved to 45%, the patient underwent stress test with adequate load and reported a good quality of life.
Highlights
Widening of QRS complexes to more than 150 ms has been defined to be one independent risk factor for cardiac mortality in patients with poor left ventricular function [1]. In these patients resynchronization of the interventricular conduction system by biventricular stimulation leads to improvement of quality of life and NYHA (New York Heart Association) class [2,3]
In open heart operations the acute hemodynamic benefit of biventricular pacing can be used by implantation of temporary epicardial electrodes facilitating weaning from extracorporeal circulation in high risk patients with impaired left ventricular function and improving cardiac output postoperatively [4,5,6]
Following preoperative diagnostics the patient was referred to our hospital for carotid endarterectomy and a simultaneous second re-do CABG procedure after previous surgery 7 and 15 years earlier
Summary
Widening of QRS complexes to more than 150 ms has been defined to be one independent risk factor for cardiac mortality in patients with poor left ventricular function [1]. In these patients resynchronization of the interventricular conduction system by biventricular stimulation leads to improvement of quality of life and NYHA (New York Heart Association) class [2,3]. In open heart operations the acute hemodynamic benefit of biventricular pacing can be used by implantation of temporary epicardial electrodes facilitating weaning from extracorporeal circulation in high risk patients with impaired left ventricular function and improving cardiac output postoperatively [4,5,6].
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