Necessity of Temporary Epicardial Pacing Wires After Surgery for Congenital Heart Disease

doi:10.1016/j.athoracsur.2014.02.020

The Annals of Thoracic Surgery

Volume 97, Issue 6, June 2014, Pages 2148-2153

https://doi.org/10.1016/j.athoracsur.2014.02.020 Get rights and content

Background

Temporary epicardial pacing wires are commonly placed in patients undergoing surgery for congenital heart disease. Though often helpful, these wires are not without risk. We aimed to identify characteristics that would obviate placement of temporary epicardial pacing wires in this patient population.

Methods

A prospective observational study was performed on patients admitted to the pediatric intensive care unit after surgery for congenital heart disease between October 2011 and October 2012. Logistic regression analysis was performed to identify independent predictors of patients in whom wires were not helpful postoperatively.

Results

Wires were placed in 213 of 249 patients. Wires were helpful in 50 patients; 23 for diagnostic purposes only, 17 for therapeutic purposes only, and 10 for both. On logistic regression analysis, absence of intraoperative arrhythmias (p < 0.01), lower arteriovenous O₂ difference (p < 0.01), and shorter duration of cardiopulmonary bypass (p = 0.050) were significant predictors of patients in whom wires were not helpful postoperatively. Further, the predicted probability based on logistic regression model using these 3 variables correctly identified 93% of patients who did not need pacing wires. Four complications (1.9%) related to wires occurred, including 1 episode of life-threatening bleeding that was found, during emergent exploration, to be due to atrial perforation at the wire insertion site.

Conclusions

Temporary epicardial pacing wires are not necessary in many patients recovering from surgery for congenital heart disease. A conservative approach to their use may therefore be warranted.

Section snippets

Study Population

Our study was approved by the Institutional Review Boards of Wayne State University and the Detroit Medical Center. We performed a prospective observational study of all patients admitted to the intensive care unit at Children's Hospital of Michigan after surgery for congenital heart disease from October 2011 to October 2012. Patients who either had a permanent pacemaker in place before surgery or who underwent pacemaker implantation during their surgery were excluded.

Operative Protocol

Our operative protocol has

Results

During the study, 249 patients met the inclusion criteria. The most common primary procedures performed in this cohort were the following: repair of tetralogy of Fallot (TOF) or TOF-type physiology (n = 28); repair of isolated ventricular septal defect (n = 27); cavopulmonary anastomoses (n = 20); repair of complete atrioventricular septal defect (n = 13); pulmonary valve replacement post-TOF (n = 12); repair of isolated atrial septal defect (n = 10); repair of partial atrioventricular septal

Comment

Placement of temporary epicardial pacing wires after surgery for congenital heart disease in both children and adults for management of postoperative arrhythmias has been commonplace for many years. The frequency of wire placement reported in the literature however, is variable, from placement of 1.2% in 1 center, as reported by Fishberger and colleagues [5], to 72% to 81% at other centers 4, 5, 6, 7. In these latter studies, temporary pacing wires were categorized as clinically useful in 23%

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Cited by (4)

Use, complications and predictors of temporary epicardial pacemakers after open heart surgery in children
2015, Cirugia Cardiovascular
Los criterios de implantación y retirada de marcapasos epicárdico transitorio en cirugía cardiaca no están claramente definidos. Revisamos uso y complicaciones de electrodos epicárdicos temporales tras circulación extracorpórea en cirugía pediátrica.
Estudio prospectivo, no aleatorizado, sobre 326 pacientes. Recogida de datos en 3 momentos: salida de quirófano, primeras 24 h y retirada de electrodos. SPSS como análisis estadístico, con χ² para comparar variables discretas.
Un total de 228 pacientes recibieron electrodos (69,9%), que siguen siendo utilizados en 30 (9,2%). Todos los electrodos se retiraron en UCI, sin complicación alguna. En 156 pacientes (68,4%) fueron retirados en las primeras 48 h; en 10 casos se mantuvieron más de 7 días. En análisis univariante no se encontró correlación entre diagnóstico preoperatorio y uso de marcapasos, y tamboco entre Fallot, canal y comunicación interventricular como grupo (p = 0,148).
Los criterios de implantación de marcapasos epicárdico transitorio son subjetivos. Menos del 10% de pacientes en nuestra serie precisaron marcapasos transitorio en el postoperatorio. El ritmo sinusal estable en las primeras 48 h predice un ritmo sinusal posteriormente, y permite la retirada segura de electrodos en UCI. Fallot, canal y comunicación interventricular como grupo no alcanzan significación estadística (p = 0,148) como predictores de uso. Se precisan series más largas para establecer predictores de uso de marcapasos postoperatorio.
To evaluate the criteria, use and complications of temporary epicardial pacemakers after pediatric open heart surgery.
A prospective non-randomised study was conducted on 326 consecutive patients. Data was collected on admission to the Intensive Care Unit arrival, at 24 hours and when the leads were removed. SPSS-11.5 program was used for statistical analysis, with χ² to compare discrete variables.
Leads were implanted in 228 (69.9%) children, and 30 (9.2%) actually used them. No untoward effects were recorded on removal. More than two-thirds (156, 68.4%) of the patients had the leads removed before 48 hours, and in 10 cases they remained for more than 7 days. Univariate analysis failed to show any correlation between diagnosis and use of pacemaker. Ventricular septal defect, atrio-ventricular septal defect, and Fallot (as a group) did not reach statistical significance (P=.148).
Pacemaker use relies on surgeon discretion. A temporary epicardial pacemaker after open heart surgery was used by 9.2% of patients in this study. Stable sinus rhythm in the first 48 hours predicts sinus rhythm thereafter, allowing safe removal of leads in Intensive Care Unit. The cluster of ventricular septal defect, atrio-ventricular septal defect, and Fallot does not reach sufficient statistical significance to predict the use of pacemaker in the post-operative period (P=.148). Longer series are needed to set predictors of temporary pacemaker use after open heart surgery.
VDI pacing with temporary esophageal and transvenous pacemaker leads to treat post-cardiac surgery cardiogenic shock
2022, Journal of Cardiothoracic Surgery
Universal implantation of temporary epicardial pacing wires after surgery for congenital heart disease: Necessity or luxury?
2020, European Journal of Cardio-thoracic Surgery
Arrhythmias: Diagnosis and Management
2015, Anesthesia for Congenital Heart Disease: Third Edition

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Original articleCongenital heart surgeryNecessity of Temporary Epicardial Pacing Wires After Surgery for Congenital Heart Disease

Background

Methods

Results

Conclusions

Section snippets

Study Population

Operative Protocol

Results

Comment

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Original article
Congenital heart surgery
Necessity of Temporary Epicardial Pacing Wires After Surgery for Congenital Heart Disease