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Routine Versus Selective Temporary Epicardial Pacing Wire Placement: A Scoping Review
Oluwakorede Akele1, Evans Osuji2, Vaishvik Patel3
1Department of Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, 06030, CT, USA. oakele@uchc.edu.
Surgery Today
|June 15, 2026
Summary
Routine placement of temporary epicardial pacing wires (TEPWs) in cardiac surgery often leads to underutilization. Selective TEPW strategies improve use and reduce unnecessary procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Temporary epicardial pacing wires (TEPWs) are commonly used for rhythm management post-cardiac surgery.
- Debate exists regarding routine versus selective TEPW placement due to low utilization and potential risks.
Purpose of the Study:
- To compare routine and selective TEPW placement strategies.
- To assess TEPW utilization, associated complications, and predictors for pacing necessity.
Main Methods:
- A scoping review was conducted following PRISMA-ScR guidelines.
- Searched major databases (PubMed, Embase, Scopus, Cochrane Library) until June 2025.
- Included 11 studies (16,874 patients) examining TEPW strategies in adult and pediatric cardiac surgery.
Main Results:
- Routine TEPW placement rates were high (73.5%-89.9%), but actual utilization was low (2.9%-29.6%).
- Selective strategies demonstrated higher utilization (30%-100%) with fewer unused wires.
- Predictors for TEPW need included intraoperative arrhythmias, prolonged cardiopulmonary bypass (CPB), and complex procedures; complications were infrequent.
Conclusions:
- Routine TEPW placement frequently results in unnecessary wire use.
- Selective TEPW strategies, guided by clinical and intraoperative predictors, can optimize patient care.
- A risk-based decision tool could improve TEPW management and reduce procedural burden.
