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Clinical and Experimental Circulation

Utility of temporary pacing following cardiac surgery

4AP2-7

Lazarescu, C.; Clavey, M.; Mertes, P. -M.; Longrois, D.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 60-60
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Background: Utility of temporary epicardial pacing wires (TEPW) following cardiac surgery is subject to debate. If it is incontestable after valvular surgery as complete heart block incidence can reach 9.6%, only 2.6% of patients undergoing isolated on-pump coronary surgery require temporary pacing. The utility of temporary wires must be analyzed against wires removal complications which can be life-threatening.

Objectives: To prospectively quantify conduction disorders following cardiac surgery, temporary pacing use and wires removal complications.

Materials and Methods: observational prospective monocentric study, including all adult patients having heart surgery with epicardial wire insertion, except those undergoing transplantation or having permanent pacemaker. Statistical analysis consisted in descriptive statistics.

Results: 236 patients were enrolled. All had ventricular and only 142 (60%) both ventricular and atrial unipolar FEP15, Ethicon epicardial wires. The most frequent conduction disorder was type I AV block. Complete heart block on day 0 was observed in 5% of all patients (6.4% after valvular surgery, 10.5% after combined surgery and only 1.4% following on-pump coronary bypass). Temporary pacing was employed for 16% of patients on day 0, mainly for accelerating sinus or junctional bradycardia. Six patients (2.5%) required permanent device insertion (5 pacemakers, all following valvular surgery and 1 defibrillator following coronary disease). Severe complications after wire removal occurred in 0.8% (1 tamponade, 1 hemothorax).

Discussion: Temporary epicardial pacing (TEP) is frequently used in the immediate postop period (16%), mainly for accelerating correction of bradycardia. Severe conduction disorders are more common following valvular or combined surgery. These abnormalities, mostly temporary, may sometimes require permanent pacemaker (2.5% in our study). On the contrary, patients undergoing isolated coronary bypass, even on-pump, rarely require postoperative pacing (1.4% of temporary complete heart block and no permanent pacemaker). Only 0.8% of serious complications were recorded and benefitrisk assessment seems in favour of temporary epicardial wires use, at least for valve/combined surgery.

Conclusion: Given the benefits of TEP and the low incidence of severe complications, this method is still the best way to treat conduction abnormalities following valve surgery. The utility of TEPW after coronary bypass remains unclear.

© 2013 European Society of Anaesthesiology