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J Thorac Cardiovasc Surg 2005;129:5-8
© 2005 The American Association for Thoracic Surgery

Editorials

Optimizing temporary perioperative cardiac pacing

^a Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NYUSA

Received for publication March 15, 2004; revisions received March 22, 2004; accepted for publication March 25, 2004.

^* Address for reprints: Henry M. Spotnitz, MD, Department of Surgery, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 14-103, 14th Floor, New York, NY 10032, USA
hms2@columbia.edu

The first 300 words of the full text of this article appear below.

Temporary perioperative cardiac pacing (TPCP) is indicated after cardiac surgery for treatment of heart block or sinus bradycardia.¹ However, TPCP protocols are often arbitrary, lacking routines to maximize cardiac output (CO) and stroke volume (SV). TPCP parameters which can be optimized include heart rate (HR), ventricular pacing site (VPS), and atrioventricular delay (AVD). Also relevant is variable right ventricular–left ventricular delay (RLD) which recently has become available in some permanent pacemakers designed for biventricular pacing (BiVP). Real-time measurement of SV with ultrasonic transit-time aortic flow probes (UFPs)² or arterial pulse contour systems make optimization of CO and SV during changes in TPCP feasible. Dramatic and possibly life-saving benefits of TPCP optimization have been anecdotally reported. Although the theory and practice of TPCP optimization (POPT) will continue to advance, review of current information can lead directly to patient benefits.

	Background

 
The US Food and Drug Administration (FDA) has approved implantable pulse generators for single-chamber atrial or ventricular (VVI) demand pacing, as well as dual-chamber (DDD) generators that can maintain the physiologic synchrony of atria and ventricles.¹ Both endocardial (transvenous) and epicardial permanent leads are available.¹ A typical DDD system uses a single atrial lead and a single ventricular lead. These leads are unipolar or bipolar (1 or 2 conductors). Unipolar systems use the body as the indifferent electrode. Transvenous leads for DDD pacing are usually placed in the right atrium (RA) and right ventricle (RV). Epicardial leads are placed externally on the RA, RV, left atrium, or left ventricle (LV). These leads sense intrinsic electrical activity and pace at low energy levels. Implantable pacemakers are adjusted by using programmers that communicate with generators through telemetry. For TPCP after cardiac surgery, temporary external pacemakers are used with removable epicardial wires. Bipolar systems using 2 wires to each chamber avoid common grounds and reduce . . . [Full Text of this Article]