Download PDF
Thorac Cardiovasc Surg 2008; 56(5): 269-273
DOI: 10.1055/s-2008-1038515
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Optimization of Atrioventricular Delay in Cardiosurgical ICU Patients by Noninvasive Cardiac Output Measurements versus Pulse Contour Analysis

F. Mellert1 , P. Lindner1 , W. Schiller1 , E. Gersing2 , I. Heinze3 , J. Kreuz4 , A. Welz1 , C. J. Preusse1
  • 1Klinik und Poliklinik für Herzchirurgie, Universität Bonn, Bonn, Germany
  • 2Zentrum Anästhesiologie-, Rettungs- und Intensivmedizin, Universität Göttingen, Abteilung Anästhesiologische Forschung, Göttingen, Germany
  • 3Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universität Bonn, Bonn, Germany
  • 4Medizinische Klinik und Poliklinik II, Universität Bonn, Bonn, Germany
Further Information

Publication History

received Dec. 18, 2007

Publication Date:
09 July 2008 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Optimizing atrioventricular (AV) delay improves cardiac output and postoperative outcome. Impedance cardiography (ICG) is a non-invasive method for CO measurement. This study evaluates the ability of two ICG methods to determine the optimal AV delay (OAVD) and to compare ICG with invasive PICCO measurements. Methods: In 14 cardiosurgical ICU patients (age 70.4 ± 12.0 yrs) with temporary pacing wires, OAVD was determined by pulse contour analysis (PICCO) and ICG (conventional ICG [CI] and electrical velocimetry [EV] ICG monitors). Cardiac output (CO) and stroke volume (SV) were measured during DDD pacing with AVD varying from 70 to 270 ms in 20-ms increments. Results: Measured OAV showed a linear correlation between PICCO and ICG: CI (r = 0.82, p < 0.0002) and EV (r = 0.84, p < 0.0002). The mean OAVD deviation between PICCO and ICG was 15.7 ± 21.0 ms (CI) and 17.1 ± 20.5 ms (EV). Hemodynamic parameters (SV increase OAVD against worst case) improved significantly (+ 11.7 ± 7.2 %, p < 0.0001). Conclusion: Inappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.

Key words

AV‐delay - ICU - pacemaker

References

  • 1 Mehta D, Gilmour S, Ward D E, Camm A J. Optimal atrioventricular delay at rest and during exercise in patients with dual chamber pacemakers: a non-invasive assessment by continuous wave Doppler.  Br Heart J. 1989;  61 161-166
    CrossrefPubMedGoogle Scholar
  • 2 Kubica J, Swiatecka G, Sielski S, Stolarczyk L, Raczak G. Left ventricular stroke volume in individuals with dual chamber pacemaker (DDD). Effect of atrioventricular delay.  Kardiol Pol. 1993;  39 452-453
    PubMedGoogle Scholar
  • 3 Cristina Porciani M, Fantini F, Musilli N. et al . A perspective on atrioventricular delay optimization in patients with dual chamber pacemaker.  PACE. 2004;  27 333-338
    PubMedGoogle Scholar
  • 4 Nishimura R, Hayes D L, Ilstrup D M, Holmes Jr D R, Tajik A J. Effect of dual-chamber pacing on systolic and diastolic function in patients with hypertrophic cardiomyopathy. Acute Doppler echocardiographic and catheterization hemodynamic study.  J Am Coll Cardiol. 1996;  27 421-430
    CrossrefPubMedGoogle Scholar
  • 5 Burchell S, Yu M, Edwards J D. Invasive techniques for estimation of cardiac output.  Int J Intensive Care. 1997;  Summer 44-50
    PubMedGoogle Scholar
  • 6 Nyboer J, Bagno S, Barnett A, Halsey R H. Radiocardiograms: electrical impedance changes of the heart in relation to electrocardiograms and heart sounds.  J Clin Invest. 1940;  19 963
    PubMedGoogle Scholar
  • 7 Kubicek W G, Karnegis J N, Patterson R P, Witsoe D A, Mattson R H. Development and evaluation of an impedance cardiac output system.  Aerosp Med. 1966;  37 1208-1212
    PubMedGoogle Scholar
  • 8 Bernstein D P. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale.  Crit Care Med. 1986;  14 904-909
    PubMedGoogle Scholar
  • 9 Ovsyshcher I, Furman S. Impedance cardiography for cardiac output estimation in pacemaker patients: review of the literature.  PACE. 1993;  16 1412-1422
    PubMedGoogle Scholar
  • 10 Ovsyshcher I, Zimlichman R, Katz A, Bondy C, Furman S. Measurement of cardiac output by impedance cardiography in pacemaker patients at rest: effects of various atrioventricular delays.  J Am Coll Cardiol. 1993;  21 761-767
    PubMedGoogle Scholar
  • 11 Kindermann M, Frohlig G, Doerr T, Schieffer H. Optimizing the AV delay in DDD pacemaker patients with high degree AV block: mitral valve Doppler versus impedance cardiography.  PACE. 1997;  20 2453-2462
    CrossrefPubMedGoogle Scholar
  • 12 Santos J F, Parreira L, Madeira J, Fonseca N, Soares L N, Ines L. Non invasive hemodynamic monitorization for AV interval optimization in patients with ventricular resynchronization therapy.  Rev Port Cardiol. 2003;  22 1091-1098
    PubMedGoogle Scholar
  • 13 Nishimura R, Hayes D, Holmes D, Tajik A. Mechanism of hemodynamic improvement by dual-chamber pacing for severe ventricular dysfunction: an acute Doppler and catheterization hemodynamic study.  J Am Coll Cardiol. 1995;  25 281-288
    CrossrefPubMedGoogle Scholar
  • 14 Gadler F, Linde C, Darpo B. Modification of atrioventricular conduction as adjunct therapy for pacemaker-treated patients with hypertrophic obstructive cardiomyopathy.  Eur Heart J. 1998;  19 132-138
    CrossrefPubMedGoogle Scholar
  • 15 de Divitiis M, Galderisi M, Santangelo L, Mayer M S, de Divitiis O, Iacono A. Impact of heart rate and atrioventricular delay on left ventricular diastolic filling in patients with dual-chamber pacing for sick sinus syndrome or atrioventricular block.  Am J Cardiol. 1998;  82 816-819
    CrossrefPubMedGoogle Scholar
  • 16 Spiess B D, Patel M A, Soltow L O, Wright I H. Comparison of bioimpedance versus thermodilution cardiac output during cardiac surgery: evaluation of a second-generation bioimpedance device.  J Cardiothorac Vasc Anesth. 2001;  15 567-573
    CrossrefPubMedGoogle Scholar
  • 17 Sageman W S, Riffenburgh R H, Spiess B D. Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery.  J Cardiothorac Vasc Anesth. 2002;  16 8-14
    CrossrefPubMedGoogle Scholar
  • 18 Van de Water J M, Miller T W, Vogel R L, Mount B E, Dalton M L. Impedance cardiography – the next vital sign technology?.  Chest. 2003;  123 2028-2033
    CrossrefPubMedGoogle Scholar
  • 19 Zacek P, Kunes P, Kobzova E, Dominik J. Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery.  Acta Medica (Hradec Kralove). 1999;  42 19-23
    PubMedGoogle Scholar
  • 20 Mabo P, Ritter P, Varin C. et al . Value of an algorithm of automatic adaptation of the atrio-ventricular delay to the instantaneous atrial rate in cardiac stimulation.  Arch Mal Coer Vaiss. 1992;  85 1001-1009
    PubMedGoogle Scholar
  • 21 Wish M, Fletcher R D, Gottdiener J S, Cohen A I. Importance of left atrial timing in the programming of dual-chamber pacemakers.  Am J Cardiol. 1987;  60 566-571
    CrossrefPubMedGoogle Scholar
  • 22 Brecker S J, Xiao H B, Sparrow J, Gibson D G. Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy.  Lancet. 1992;  340 1308-1312
    CrossrefPubMedGoogle Scholar
  • 23 Auricchio A, Stellbrink C, Block M. et al . Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The pacing therapies for congestive heart failure study group. The Guidant Congestive Heart Failure Research Group.  Circulation. 1999;  99 2993-3001
    PubMedGoogle Scholar
  • 24 Kass D A, Chen C H, Curry C. et al . Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay.  Circulation. 1999;  99 1567-1573
    PubMedGoogle Scholar
  • 25 Ritter P, Dib J C, Mahaux V. et al . New method for determination the optimal AV delay in patients paced in DDD mode for complete AV block. Abstract session 40: Bradicardia VII: New concepts in rate adaptive sensors.  PACE. 1995;  18 855
    PubMedGoogle Scholar
  • 26 Jansen A H, Bracke F A, van Dantzig J M. et al . Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.  Am J Cardiol. 2006;  97 552-557
    CrossrefPubMedGoogle Scholar
  • 27 Braun M U, Schnabel A, Rauwolf T, Schulze M, Strasser R H. Impedance cardiography as a noninvasive technique for atrioventricular interval optimization in cardiac resynchronization therapy.  J Interv Card Electrophysiol. 2005;  13 223-229
    CrossrefPubMedGoogle Scholar
  • 28 Heinroth K M, Elster M, Nudig S. et al . Impedance cardiography: a useful and reliable tool in optimization of cardiac resynchronization devices.  Europace. 2007;  9 744-750
    CrossrefPubMedGoogle Scholar
  • 29 Zoremba N, Bickenbach J, Krauss B, Rossaint R, Kuhlen R, Schälte G. Comparison of electrical velocimatry and thermodilution techniques for the measurement of cardiac output.  Acta Anaesthesiol Scand. 2007;  51 1314-1319
    CrossrefPubMedGoogle Scholar
  • 30 Heringlake M, Handke U, Hanke T. et al . Lack of agreement between thermodilution and electrical velocimetry cardiac output measurements.  Intensive Care Med. 2007;  33 2168-2172
    CrossrefPubMedGoogle Scholar

Dr. Fritz Mellert

Klinik und Poliklinik für Herzchirurgie
Universität Bonn

Sigmund-Freud-Straße 25

53127 Bonn

Germany

Phone: + 49 22 82 87 40 92

Fax: + 49 22 82 87 13 48

Email: fritz.mellert@uni-bonn.de

      >