Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-24T13:24:42.778Z Has data issue: false hasContentIssue false
  • English
  • Français

Congenital cardiac surgery without routine placement of wires for temporary pacing

Published online by Cambridge University Press:  31 October 2007

Steven B. Fishberger ,
Anthony F. Rossi ,
Juan M. Bolivar ,
Leo Lopez ,
Robert L. Hannan  and
Redmond P. Burke
Steven B. Fishberger*
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Anthony F. Rossi
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Juan M. Bolivar
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Leo Lopez
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Robert L. Hannan
Affiliation:
Divisions of Cardiothoracic Surgery, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Redmond P. Burke
Affiliation:
Divisions of Cardiothoracic Surgery, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
*
Correspondence to: Steven B. Fishberger MD, Division of Cardiology, Miami Children’s Hospital, 3200 S.W. 60th Court, Miami, FL, 33155, USA. Tel: (305) 662 8301; Fax: (305) 662 8304; E-mail: steven.fishberger@mch.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Temporary pacing wires have been associated with serious postoperative complications. Recommendations for their routine use after open heart surgery are decades old, and may not reflect current surgical techniques and outcomes.

Methods

The electronic web-enabled medical records of all patients undergoing congenital cardiac surgery from February, 2002, through December, 2005, were reviewed, excluding patients undergoing implantation of pacemakers as a primary procedure, or those undergoing ligation of a patent arterial duct.

Results

There were 1193 surgical procedures performed, 1041 with cardiopulmonary bypass. Median age of the patients was 5.8 months, with a range from 0 days to 54 years, weighing 6.2 kilograms, with a range from 1 to 114 kilograms. Mortality prior to discharge was 2.5%, and median postoperative stay was 6 days. No deaths were attributed to arrhythmias. Temporary pacing wires were placed 14 times (1.2%). Indications for placement included sinus nodal dysfunction in 8 patients, preoperative in 4 and intraoperative in 4, high degree atrioventricular block in 4 patients, and intraoperative atrial flutter in 2 patients. Of these patients, 4 (0.3%) eventually underwent permanent implantation of a pacemaker, 2 for persistent sinus nodal dysfunction, and 2 for persistent atrioventricular block. Postoperative junctional ectopic tachycardia requiring antiarrhythmic therapy occurred in 9 patients (0.8%). All recovered without incident, and none were treated with temporary pacing.

Conclusions

The diminished risk of unexpected postoperative arrhythmias in the current era alleviates the necessity for routine placement of temporary pacing wires. Those institutions with experienced surgical and cardiac critical care teams may be able to predict the need for temporary pacing wires preoperatively or intraoperatively.

Keywords

Paediatricsarrhythmiacardiac pacing
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 1 , February 2008 , pp. 96 - 99
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lillehei, CW, Sellers, RD, Bonnabeau, RC, Eliot, RS. Chronic postsurgical complete heart block. With particular reference to prognosis, management, and a new P-wave pacemaker. J Thorac Cardiovasc Surg 1963; 46: 436–456.CrossRefGoogle Scholar
2. Waldo, AL, MacLean, WA, Cooper, TB, Kouchoukos, NT, Karp, RB. Use of temporarily placed epicardial atrial wire electrodes for the diagnosis and treatment of cardiac arrhythmias following open-heart surgery. J Thorac Cardiovasc Surg 1978; 76: 500–505.CrossRefGoogle ScholarPubMed
3. Greenwood, RD, Rosenthal, A, Sloss, LJ, LaCorte, M, Nadas, AS. Sick sinus syndrome after surgery for congenital heart disease. Circulation 1975; 52: 208–213.CrossRefGoogle ScholarPubMed
4. Yabek, SM, Akl, BF, JrBerman, W, Neal, JF, Dillon, T. Use of atrial epicardial electrodes to diagnose and treat postoperative arrhythmias in children. Am J Cardiol 1980; 46: 285–289.Google Scholar
5. Del Nido, P, Goldman, BS. Temporary epicardial pacing after open heart surgery: complications and prevention. J Card Surg 1989; 4: 99–103.Google Scholar
6. Bolton, JW, JrMayer, JE. Unusual complication of temporary pacing wires in children. Ann Thorac Surg 1992; 54: 769–770.CrossRefGoogle ScholarPubMed
7. Gal, ThJ, Chaet, MS, Novitzky, D. Laceration of a saphenous vein graft by an epicardial pacemaker wire. J Cardiovasc Surg 1998; 39: 221–222.Google Scholar
8. Gentry, WH, Hassan, AA. Complications of retained epicardial pacing wires: an unusual bronchial foreign body. Ann Thorac Surg 1993; 56: 1391–1393.CrossRefGoogle ScholarPubMed
9. Preisman, S, Cheng, DC. Lifethreatening ventricular dysrhythmias with inadvertent asynchronous temporary pacing after cardiac surgery. Anesthesiology 1999; 91: 880–883.CrossRefGoogle ScholarPubMed
10. Dougenis, D, Dark, JH, Gold, RG. Perforation of the left ventricle by a temporary pacing lead. Intensive Care Med 1990; 16: 520–521.Google Scholar
11. Weindling, SN, Saul, JP, Gamble, WJ, Mayer, JE, Wessel, D, Walsh, EP. Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 1998; 82: 525–527.CrossRefGoogle ScholarPubMed
12. Delaney, JW, Moltedo, JM, Dziura, JD, Kopf, GS, Snyder, CS. Early postoperative arrhythmias after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2006; 131: 1296–1300.Google Scholar
13. Hoffman, TM, Bush, DM, Wernovsky, G, et al. . Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. Ann Thorac Surg 2002; 74: 1607–1611.CrossRefGoogle ScholarPubMed
14. Walsh, EP, Saul, JP, Sholler, GF, et al. . Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease. J Am Coll Cardiol 1997; 29: 1046–1053.Google Scholar
15. Zimmerman, FJ, Starr, JP, Koenig, PR, Smith, P, Hijazi, ZM, Bacha, EA. Acute hemodynamic benefit of multisite ventricular pacing after congenital heart surgery. Ann Thorac Surg 2003; 75: 1775–1780.CrossRefGoogle ScholarPubMed
16. Chung, MK. Proarrhythmic effects of post-operative pacing intended to prevent atrial fibrillation: evidence from a clinical trial. Card Electrophysiol Rev 2003; 7: 143–146.Google Scholar
17. Imren, Y, Zor, H, Tasoglu, I. Ventricular fibrillation following removal of temporary epicardial pacemaking wires. Cardiol Young 2005; 15: 654–655.Google Scholar
18. Kanoh, M, Ishikawa, S, Suzuki, M, et al. . Postoperative infections related to pacing wires, pulmonary arterial catheters, and drainage tubes temporarily inserted during open-heart surgery. Jpn J Thorac Cardiovasc Surg 1998; 46: 170–174.CrossRefGoogle ScholarPubMed
19. Puskas, JD, Sharoni, E, Williams, WH, Peterson, R, Duke, P, Guyton, RA. Is routine use of temporary epicardial pacing wires necessary after either OPCAB or conventional CABG/CPB? Heart Surg Forum 2003; 6: E103–E106.Google Scholar
20. Welke, KF, Shen, I, Ungerleider, RM. Current assessment of mortality rates in congenital cardiac surgery. Ann Thorac Surg 2006; 82: 164–170.Google Scholar
21. Rossi, AF, Khan, DM, Hannan, R, Bolivar, J, Zaidenweber, M, Burke, R. Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery. Intensive Care Med 2005; 31: 98–104.Google Scholar
22. Batra, AS, Chun, DS, Johnson, TR, et al. . A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease. Pediatr Cardiol 2006; 27: 51–55.Google Scholar