Temporary Epicardial Pacing After Adult Cardiac Surgery

Abstract

Introduction: Temporary epicardial pacing wires (TEPW) have been routinely used in cardiac surgery in early postoperative period. Purpose of the study is to determine predictors for need of temporary pacing wires after surgery that will safely limit their usage and to document complications associated with the wires. Patients and Methods: This prospective study involved 112 patients operated at our institution from April 2010 to October 2010, who received TEPW following surgery. Surgical procedures included 34 isolated coronary revascularization, 51 valve replacement, 11 revascularization with valve replacement, 14 mitral reconstruction, 2 ascending aorta replacement. Results: Among 112 patients, 93 (83.1%) were never paced. Nineteen (16.9%) patients required pacing during weaning and 10 patients, required further pacing in intensive care unit. Indications for pacing included atrioventricular block in 7 (36.8%), sinus bradycardia in 2 (10.5%), junctional rhythm in 9 (47.4%) and low cardiac output in 1 (5.2%) patient. Atrioventricular block, junctional rhythm, postperfusion atrial fi brillation, inotropic agent requirement leaving the operating room, pacing requirement during weaning and mitral surgery are found to be the predictors for requirement of TEPWs. No complications were observed related with the use or removal of TEPWs. Conclusion: Routine placement of TEPWs is not necessary after cardiac surgery. Patients having rhythm disturbances after procedure and requiring pacemacer support during weaning of cardiopulmonary by-pass, require further pacemaker support in intensive care unit with higher probability. Depending on our data, because of potential complications related with use of wires, selective use of TEPWs for patients with identifi ed predictors can be recommended.