Short-Term Atrial Pacing and Hemodynamics After Cardiac Surgery
STAPH-CS Study: Short-Term Atrial Pacing and Hemodynamics After Cardiac Surgery - A Prospective Randomized Evaluation of Variable-Rate Atrial Stimulation After Cardiac Surgery With Cardiopulmonary Bypass
Saint-Joseph University
200 participants
Aug 4, 2025
INTERVENTIONAL
Conditions
Summary
The goal of this clinical trial is to learn whether temporary atrial pacing improves heart function after cardiac surgery under cardiopulmonary bypass (CPB). It will also help determine the best pacing rate during the first 24 hours after surgery. The main questions it aims to answer are: * Does atrial pacing improve cardiac output after surgery? * Is 70, 80, or 90 bpm the most effective pacing rate? * Does pacing reduce the risk of atrial fibrillation after surgery?
Eligibility
Inclusion Criteria5
- Patients aged 18 years or older
- Cardiac surgery under CPB (coronary artery bypass grafting, valve replacement or repair, or combined procedures)
- Placement of epicardial atrioventricular pacing wires during surgery
- Placement of a Swan-Ganz catheter intraoperatively
- Signed informed consent
Exclusion Criteria9
- Emergency surgery
- Patients with an internal pacemaker
- History of permanent atrial fibrillation
- Complete atrioventricular block upon weaning from CPB
- Junctional rhythm upon weaning from CPB
- Sinus rhythm < 50 bpm upon weaning from CPB
- Failure of atrial or dual-chamber pacing (patients paced in ventricular mode VVI)
- Contraindication to Swan-Ganz catheter placement
- Hemodynamic instability defined by significant bleeding or tamponade requiring surgical re-intervention, or the need for escalating doses of vasopressors (Norepinephrine > 1 μg/kg/min, Dobutamine > 10 μg/kg/min)
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Interventions
At four standardized time points (H0: arrival in the ICU, H6, H12, H24), a transient pacing sequence at 70, 80, and 90 bpm is conducted, with each rate applied for 10 minutes to allow stabilization, followed by recording of the hemodynamic profile and blood pressure, as follows: * If the patient has a spontaneous rhythm between 50 and 69 bpm, measurements are taken at the spontaneous rate, then at 70 bpm, 80 bpm, and finally 90 bpm * If the patient has a spontaneous rhythm between 70 and 79 bpm, measurements are taken at the spontaneous rate, then at 80 bpm, and finally at 90 bpm * If the patient has a spontaneous rhythm between 80 and 89 bpm, measurements are taken at the spontaneous rate, then at 90 bpm * If the patient has a spontaneous rhythm ≥ 90 bpm, measurements are taken at the spontaneous rate only
At H0, H6, H12, and H24, they will undergo transient pacing at 70, 80, and 90 bpm, following the same measurement protocol (10 minutes per rate), followed by recording of the hemodynamic profile and blood pressure, as follows: * If the patient has a rhythm between 50 and 69 bpm, measurements will be taken at the spontaneous rate, then at 70 bpm, 80 bpm, and finally 90 bpm * If the patient has a rhythm between 70 and 79 bpm, measurements will be taken at the spontaneous rate, then at 80 bpm, and finally at 90 bpm * If the patient has a rhythm between 80 and 89 bpm, measurements will be taken at the spontaneous rate, then at 90 bpm * If the patient has a rhythm ≥ 90 bpm, measurements will be taken at the spontaneous rate only Outside the pacing periods at different rates, patients in the non-pacing group will remain on their spontaneous sinus rhythm.
Locations(1)
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NCT07082283