Standardized Temporary Atrial Epicardial Wire Locations Lead to Enhanced Atrial Signal Identification

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Electrophysiology

Background:

• Arrhythmias are common post-pediatric cardiac surgery, increasing morbidity and mortality.
• Atrial epicardial wires (AEW) aid diagnosis but have location-dependent pacing/sensing variability.
• No prior pediatric studies prospectively evaluated optimal AEW placement.

Purpose of the Study:

• To compare atrial amplitudes, pacing sensitivities, and thresholds of AEW placed at Bachmann's Bundle (BB) and interatrial groove near right pulmonary veins (IGRPV) versus standard locations.
• To identify the ideal placement for improved diagnostic and pacing capabilities.

Main Methods:

• Multicenter prospective study comparing AEW at BB/IGRPV versus standard sites.
• Atrial ECG amplitudes and ventricular amplitudes calculated using the AtriAmp system.
• Temporary pacemaker documented sensing and thresholds.
• Statistical analysis included ANOVA and mixed effects linear regression.

Main Results:

• AEW at BB and IGRPV demonstrated significantly larger atrial amplitudes in the first 24 hours post-surgery.
• Atrial amplitudes showed an initial decline then increased, with the largest increase observed at BB.
• Atrial sensing was statistically greater with BB-IGRPV placement compared to standard locations.
• No significant differences in atrial pacing thresholds were found across sites or over time.

Conclusions:

• Standardizing AEW placement at Bachmann's Bundle (BB) maximizes atrial ECG amplitude and sensing parameters.
• This optimal placement does not compromise atrial pacing thresholds.
• BB placement represents a superior strategy for post-pediatric cardiac surgery arrhythmia management.