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Pacemaker therapy of postoperative arrhythmias after pediatric cardiac surgery

Skippen, Peter MBBS, FJFICM, FANZCA, FRCPC, MHA; Sanatani, Shubhayan MD, FRCPC; Froese, Norbert MD, FRCPC; Gow, Robert M. MB, BS, FRACP, FCSANZ, MedStats

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3181ae5b8a
Review Articles

Objective: To summarize the practical operation of temporary pacemakers in common use pertinent to the intensivist caring for the postcardiac patient. Pacemaker therapy is commonly required in the postoperative period after congenital cardiac surgery.

Data Synthesis: Monitoring the hemodynamic status and availability of equipment for resuscitation is always important in any patient requiring a temporary pacemaker. Two important scenarios to consider in the pediatric intensive care unit are: 1) the patient in whom pacing has been initiated to optimize cardiac function; and 2) the patient without demonstrable spontaneous electrical activity or with extreme bradycardia. A number of different models of temporary pacemaker are available. Management of the child requiring cardiac pacing requires an understanding of the indications for pacing, a thorough knowledge of the available pacemaker, and an ability to troubleshoot problems.

Conclusions: As the most common arrhythmias post congenital cardiac surgery involve either rate or conduction abnormalities, temporary pacemaker systems are a common form of electrical therapy in the postoperative period.

Author Information

From the Pediatric Intensive Care Unit (PS), Cardiac Pacing and Electrophysiology (SS), Children's Heart Centre, Department of Anesthesia (NF), British Columbia Children's Hospital, BC, Canada; and Division of Pediatric Cardiology (RMG), Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.

Dr. Sanatani has received an unrestricted research grant from Medtronic. The remaining authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies