COMPARING THE OUTCOMES OF ROUTINE AND SELECTIVE EPICARDIAL PACING WIRE PLACEMENT:A SINGLE-CENTER EXPERIENCE OF 237 PATIENTS
Objective: Recently, the use of epicardial pacing wires (EPW) has become the standard of care for patients undergoing open-heart surgery (OHS) at many cardiovascular surgery centers. However, the routine use of EPWs after OHS is increasingly questioning due to their potentially lethal complications and limited efficacy. Here, we aimed to investigate the impact of EPW placement on in-hospital mortality and to compare the frequency of the EPW related complications in patients receiving routine or selective EPW placement after elective OHS.
Methods: A total of 237 patients undergoing OHS in our clinic (ORDU UNÄ°VERSTY TRAÄ°NÄ°NG AND RESEARCH HOSPÄ°TAL) were enrolled in this study. Study subjects were randomly assigned to one of the groups: Routine or selective EPW placement. In the latter, EPWs were placed according to the presence of intraoperative bradycardia with hemodynamic compromise, nodal or junctional arrhythmias, atrioventricular block or ventricular tachycardia.
Results: There were 95 patients (40 %) receiving routine EPW and 142 (60%) patients receiving selective EPW. Active pacing was performed or required in 13 patients (5.4 %). Five of them were in routine EPW group and 8 were in the selective EPW group (p = 0.902). Active pacing requirement was similar in coronary artery bypass grafting and valvular surgery ( 5 % vs. 9 %, p = 0.712, respectively). Permanent pacing was required in any of the subjects. Complications related to EPW occurred in 17 patients receiving routine EPW and 2 patients receiving selective EPW (p< 0.001). Routine EPW implantation was significantly correlated with the development of the complications (r= 0.309, p<0.001).
Conclusion: Our findings indicate that the number of patients requiring temporary pacing after OHS is quite low and implementing an EPW is associated with potentially hazardous complications.Â Selective EPW placement compared to routine EPW placement is associated with fewer postoperative complications.
Chua J, Schwarzenberger J, Mahajan A. Optimization of pacing after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2012;26(2):291-301.
Liebold A, Wahba A, Birnbaum DE. Low-energy cardioversion with epicardial wire electrodes: a new treatment of atrial fibrillation after open-heart surgery. Circulation. 1998;98(9):883-6.
De Belder MA, Malik M, Ward DE, Camm AJ. Pacing modalities for tachycardia termination. Pacing Clin Electrophysiol. 1990;13(2):231-48.
Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review: part 1: general considerations in the management of epicardial pacing. Anesthesia. 2007;62(3):264-71.
Puskas JD, Sharoni E, Williams WH, Petersen R, Duke P, Guyton RA. Is routine use of temporary epicardial pacing wires necessary after either OPCAB or conventional CABG/CPB? Heart Surg Forum. 2003;6(6):E103-6.
Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review. Part 2: Selection of epicardial pacing modes and troubleshooting. Anesthesia. 2007;62(4):364-73.
Worth PJ, Conklin P, Prince E, Singh AK. Migration of retained right ventricular epicardial pacing wire into the pulmonary artery: a rare complication after heart surgery. J Thorac Cardiovasc Surg. 2011;142(3):e136-8.
Juchem G, Golczyk K, Kopf C, Reichart B, Lamm P. Bizarre case of migration of a retained epicardial pacing wire. Europace. 2008;10(11):1348-9.
Price C, Keenan DJ. Injury to a saphenous vein graft during removal of a temporary epicardial pacing wire electrode. Br Heart J. 1989;61(6):546-7.
Willman VL, Howard H, Riberi A, Cooper T, Hanlon CR. Surgical heart block. Influence of electrical pacing, cardiotonic drugs, and body temperature. Arch Surg. 1961;83:496-501.
Pianta RM, Ferrari AD, Heck AA, Ferreira DK, Piccoli Jda C, Albuquerque LC, et al. Atrioventricular block in coronary artery bypass surgery: perioperative predictors and impact on mortality. Rev Bras Cir Cardiovasc. 2015;30(2):164-72.
Ferrari AD, Sussenbach CP, Guaragna JC, Piccoli Jda C, Gazzoni GF, Ferreira DK, et al. Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors, and hospital evolution. Rev Bras Cir Cardiovasc. 2011;26(3):364-72.
Alwaqfi NR, Ibrahim KS, Khader YS, Baker AA. Predictors of temporary epicardial pacing wires use after valve surgery. J Cardiothorac Surg. 2014;9:33.
Lazarescu C, Mertes PM, Longrois D. [Temporary epicardial pacing following cardiac surgery: practical aspects]. Ann Fr Anesth Reanim. 2013;32(9):592-601.
Aser R, Orhan C, Niemann B, Roth P, Perepelitsa A, Attmann T, et al. Temporary epicardial pacemaker wires: the significance of position and electrode type. Thorac Cardiovasc Surg. 2014;62(1):66-9.
Emkanjoo Z, Mirza-Ali M, Alizadeh A, Hosseini S, Jorat MV, Nikoo MH, et al. Predictors and frequency of conduction disturbances after open-heart surgery. Indian Pacing Electrophysiol J. 2008;8(1):14-21.
Imren Y, Benson AA, Oktar GL, Cheema FH, Comas G, Naseem T. Is the use of temporary pacing wires following coronary bypass surgery really necessary? J Cardiovasc Surg (Torino). 2008;49(2):261-7.
Asghar MI, Khan AA, Iqbal A, Arshad A, Afridi I. Placing epicardial pacing wires in isolated coronary artery bypass graft surgery--a procedure routinely done but rarely beneficial. J Ayub Med Coll Abbottabad. 2009;21(1):86-90.
Elmi F, Tullo NG, Khalighi K. Natural history and predictors of temporary epicardial pacemaker wire function in patients after open-heart surgery. Cardiology. 2002;98(4):175-80.
Alhuzaimi A, Roy N, Duncan WJ. Cardiac strangulation from epicardial pacemaker: early recognition and prevention. Cardiol Young. 2011;21(4):471-3.
Del Nido P, Goldman BS. Temporary epicardial pacing after open-heart surgery: complications and prevention. J Card Surg. 1989;4(1):99-103.
Khorsandi M, Muhammad I, Shaikhrezai K, Pessotto R. Is it worth placing ventricular pacing wires in all patients post-coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2012;15(3):489-93.
- There are currently no refbacks.
Copyright (c) 2019 emced khalil
This work is licensed under a Creative Commons Attribution 4.0 International License.