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Bary, Christian von; Laski, Viktoria; Fricke, Hannes; Linhardt, Florian; Reithmann, Christopher; Fiek, Michael (2018): Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy. In: Pace-Pacing and Clinical Electrophysiology, Vol. 41, No. 6: pp. 578-582
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Abstract

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 approachessedation only or general anaesthesia including CMVcan be safely implemented during CRT implantation.