Is routine use of temporary epicardial pacing wires necessary after either OPCAB or conventional CABG/CPB?

Placement of temporary epicardial pacing wires (PWs) after coronary artery bypass graft (CABG) is routine procedure in many centers, despite infrequent but significant complications, including hemorrhage, tamponade, and death. The resurgence of off-pump CAB (OPCAB) prompted a reexamination of this practice.

Two hundred unselected coronary patients were prospectively randomized to undergo either OPCAB or conventional CABG on cardiopulmonary bypass (CAB G /CPB). Three patients were excluded after randomization. Management, including placement or avoidance of PWs, followed unbiased, criteria-driven protocols. Patients requiring pacing immediately prior to chest closure (bradycardia with cardiac ou t put < 2.2 L/min per m2, nodal or junctional arrhythmias, atrioventricular block) received PWs. In all other patients use of PWs was avoided. Duration of pacing and complications related to PW placement or avoidance were recorded.

PWs were placed in 33 of 197 (17%) of patients, 23 of whom were paced after arrival in the intensive care unit and 10 of whom were never paced. Twelve OPCAB versus 21 CABG/CPB patients had PWs (P =.08). Patients with PWs were older, more commonly female, had more chronic obstructive pulmonary disease, and had longer hospital stays than those not requiring PWs. Preoperative beta blocker use, coronary anatomy, and number of grafts performed were not correlated with need for PWs. No patient without PWs required postoperative pacing by any means nor suffered any complication attributable to avoidance of PWs.

Need for pacing immediately prior to chest closure accurately and safely identifies coronary patients who will require postoperative pacing after OPCAB or CABG/ CPB. Routine use of PWs is unnecessary. OPCAB may be associated with a reduced requirement for PWs.