Transesophageal atrial pacing in anesthetized patients with coronary artery disease

Hemodynamic benefits versus risk of myocardial ischemia

Charles W. Hogue, Victor G. Dávila-Román, Charles Pond, Edward Hauptmann, David Braby, Demetrios G. Lappas

Research output: Contribution to journalArticle

Abstract

Background: Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery. Methods: Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 μg/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 heats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP. Results: Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively. Conclusions: Control of heart rate with TEAP restores intraoperative hemodynamics to baseline in patients in whom bradycardia and a hypotensive response develop before coronary artery bypass surgery. When using TEAP for patients with severe coronary artery disease, these results support using the lowest TEAP rate titrated to achieve optimal hemodynamics, while closely monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm.

Original languageEnglish (US)
Pages (from-to)69-76
Number of pages8
JournalAnesthesiology
Volume85
Issue number1
DOIs
StatePublished - 1996
Externally publishedYes

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Myocardial Ischemia
Coronary Artery Disease
Hemodynamics
Transesophageal Echocardiography
Bradycardia
Anesthesia
Coronary Artery Bypass
Cardiac Output
Electrocardiography
Heart Rate
Blood Pressure
Fentanyl
Ventricular Pressure
Stroke Volume
Hypotension
Heart Ventricles
Hot Temperature
Oxygen

Keywords

  • Cardiac pacing: transesophageal
  • Coronary artery disease: myocardial ischemia
  • Echocardiography: transesophageal
  • Surgery: coronary artery bypass

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Transesophageal atrial pacing in anesthetized patients with coronary artery disease : Hemodynamic benefits versus risk of myocardial ischemia. / Hogue, Charles W.; Dávila-Román, Victor G.; Pond, Charles; Hauptmann, Edward; Braby, David; Lappas, Demetrios G.

In: Anesthesiology, Vol. 85, No. 1, 1996, p. 69-76.

Research output: Contribution to journalArticle

Hogue, Charles W. ; Dávila-Román, Victor G. ; Pond, Charles ; Hauptmann, Edward ; Braby, David ; Lappas, Demetrios G. / Transesophageal atrial pacing in anesthetized patients with coronary artery disease : Hemodynamic benefits versus risk of myocardial ischemia. In: Anesthesiology. 1996 ; Vol. 85, No. 1. pp. 69-76.
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T1 - Transesophageal atrial pacing in anesthetized patients with coronary artery disease

T2 - Hemodynamic benefits versus risk of myocardial ischemia

AU - Hogue, Charles W.

AU - Dávila-Román, Victor G.

AU - Pond, Charles

AU - Hauptmann, Edward

AU - Braby, David

AU - Lappas, Demetrios G.

PY - 1996

Y1 - 1996

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AB - Background: Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery. Methods: Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 μg/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 heats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP. Results: Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively. Conclusions: Control of heart rate with TEAP restores intraoperative hemodynamics to baseline in patients in whom bradycardia and a hypotensive response develop before coronary artery bypass surgery. When using TEAP for patients with severe coronary artery disease, these results support using the lowest TEAP rate titrated to achieve optimal hemodynamics, while closely monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm.

KW - Cardiac pacing: transesophageal

KW - Coronary artery disease: myocardial ischemia

KW - Echocardiography: transesophageal

KW - Surgery: coronary artery bypass

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