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Published on: September 15, 2023
Is use of temporary pacing wires following coronary bypass surgery really necessary?
Y Imren1, A A Benson, G L Oktar
1Cardiovascular Surgery Department, Gazi University Medical Faculty, Ankara, Turkey. yimren@gmail.com
Insights
Temporary epicardial pacing wires (TEPW) are frequently overused in cardiac surgery. Identifying predictors for TEPW use can help limit their application to select patients, reducing potential complications.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Temporary epicardial pacing wires (TEPW) are commonly used after coronary bypass grafting.
- Routine use of TEPW may lead to significant complications.
- Predicting TEPW necessity can optimize patient care.
Purpose of the Study:
- To identify variables that predict the need for TEPW implantation.
- To reduce the overuse of TEPW in cardiac surgery.
Main Methods:
- Prospective study of 564 patients undergoing coronary artery bypass grafting (CABG).
- Patients were divided into on-pump (ONCAB) and off-pump (OPCAB) groups.
- TEPW criteria included various arrhythmias like bradycardia, AV block, and atrial fibrillation.
Main Results:
- Only 5.5% of patients received TEPW intraoperatively (6.8% ONCAB, 4.1% OPCAB).
- No TEPW-associated complications were reported.
- One OPCAB patient required a permanent pacemaker; two non-paced OPCAB patients needed transvenous pacing.
Conclusions:
- TEPW implantation is overused in cardiac surgery.
- Identifying independent predictors can limit TEPW use to essential cases.
- Selective TEPW use is recommended.
Aim:
Temporary epicardial pacing wires (TEPW) which are routinely used after coronary bypass grafting may result in significant complications. We sought to identify variables that predict TEPW implantation and thereby limit their use.
Methods:
This prospective study enrolled 564 patients (296 underwent coronary artery bypass grafting with cardiopulmonary bypass [ONCAB] and 268 underwent off-pump coronary artery bypass grafting, OPCAB). TEPW were placed in patients with the intraoperative presence of one or more of the following criteria: sinus bradycardia, sinus arrest, nodal/junctional rhythms, atrioventricular block, bundle branch block, ventricular tachycardia, or onset of atrial fibrillation.
Results:
Only 31 (5.5%) patients [ONCAB: 20 (6.8%) (ventricular: 14, bichamber: 6); OPCAB: 11 (4.1%) (ventricular: 9, bichamber: 2)] had temporary epicardial pacing wires implanted intraoperatively. Indications for using temporary epicardial pacing wires for ONCAB were sinus bradycardia (8), nodal/junctional rhythms (3), atrioventricular block (3), atrial fibrillation (4), and bundle branch block (2), and for OPCAB were sinus bradycardia (8), nodal/junctional rhythms (2), and atrioventricular block (1). Mean duration for pacing was 22.4 h for the ONCAB group and 11.3 h for the OPCAB group. There were no temporary epicardial pacing wires associated complications. One paced OPCAB patient required a permanent pacemaker and 2 non-paced OPCAB patients required transvenous pacing wires. Univariate and multivariate analyses were also conducted to determine risk factors for TEPW.
Conclusion:
TEPW implantation is overused in cardiac surgery and by identifying independent predictors for pacing we conclude that TEPW use should be limited to a select few.
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