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Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy
Author(s) -
Bary Christian,
Laski Viktoria,
Fricke Hannes,
Linhardt Florian,
Reithmann Christopher,
Fiek Michael
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13332
Subject(s) - medicine , cardiac resynchronization therapy , lead (geology) , cardiology , ventricular function , cardiac function curve , mechanical ventilation , ventilation (architecture) , heart failure , ejection fraction , mechanical engineering , geomorphology , engineering , geology
Background Intraoperative controlled mechanical ventilation (CMV) changes the intrathoracic geometry and may impact postoperative left ventricular (LV) lead function after CRT implantation. This multicenter study investigates the effect of intraoperative ventilation setting (spontaneous breathing [SB] vs CMV) on postoperative LV lead function taking into account patients’ body mass index (BMI). Methods CRT implantation was performed at two centers during SB in 92 and during CMV in 73 patients. Follow‐up was carried out after 3 ± 5 and 36 ± 53 days. Functional lead parameters (FLP; pacing threshold and impedance), postoperative adverse events (A; phrenic nerve stimulation [PNS] and lead malfunction), and patients’ BMI were assessed. Delta values of FLP between baseline and follow‐up visits were analyzed applying an analysis of covariance model to detect subclinical alterations in LV lead function. Results AE occurred in a total of 36 (21%) patients. PNS was observed in 26 (15%) patients and LV lead repositioning due to malfunction was necessary in 10 (6%) patients. Both AE and FLP delta values between baseline and follow‐up were not associated with intraoperative ventilation settings nor the patients’ BMI. Conclusions This study demonstrates that there is no impact of the intraoperative ventilation setting (SB vs CMV) on postoperative FLP or the occurrence of AE. This is also the case taking into account the BMI. With respect to these findings both approaches—sedation only or general anaesthesia including CMV—can be safely implemented during CRT implantation.