Is Routine Use of Temporary Epicardial Pacing Wires Necessary after Either OPCAB or Conventional CABG/CPB?
Objectives: Placement of temporary epicardial pacing wires (PWs) after coronary artery bypass graft (CABG) is routine procedure in many centers, despite infrequent but significant complications, including hemorrhage, tamponade, and death. The resurgence of off-pump CAB (OPCAB) prompted a reexamination of this practice.
Methods: Two hundred unselected coronary patients were prospectively randomized to undergo either OPCAB or conventional CABG on cardiopulmonary bypass (CABG/CPB). Three patients were excluded after randomization. Management, including placement or avoidance of PWs, followed unbiased, criteria-driven protocols. Patients requiring pacing immediately prior to chest closure (bradycardia with cardiac output <2.2 L/min per m2, nodal or junctional arrhythmias, atrioventricular block) received PWs. In all other patients use of PWs was avoided. Duration of pacing and complications related to PW placement or avoidance were recorded.
Results: PWs were placed in 33 of 197 (17%) of patients, 23 of whom were paced after arrival in the intensive care unit and 10 of whom were never paced. Twelve OPCAB versus 21 CABG/CPB patients had PWs (P = .08). Patients with PWs were older, more commonly female, had more chronic obstructive pulmonary disease, and had longer hospital stays than those not requiring PWs. Preoperative beta blocker use, coronary anatomy, and number of grafts performed were not correlated with need for PWs. No patient without PWs required postoperative pacing by any means nor suffered any complication attributable to avoidance of PWs.
Conclusions: Need for pacing immediately prior to chest closure accurately and safely identifies coronary patients who will require postoperative pacing after OPCAB or CABG/ CPB. Routine use of PWs is unnecessary. OPCAB may be associated with a reduced requirement for PWs.
Baerman JM, Kireh MM. Buitlair M, et al. 1987. The natural history and determinants of conduction defects following coronary artery bypass surgery. Ann Thorac Surg 44:150-3.nBolton JW, Mayer JE Jr. 1992. Unusual complication of temporary pacing wires in children. Ann Thorac Surg 54:769-70.nChu A, Calliff RM, Pryor DB, et al. 1987. Prognosis effect of bundle branch block related to coronary artery bypass grafting. Am J Cardiol 59:798-805.nDel Nido P, Goldman BS. 1989. Temporary epicardial pacing after open heart surgery: complications and prevention. J Card Surg 4:99-103.nGal ThJ, Chaet MS, Novitzky D. 1998. Laceration of saphenous vein graftby an epicardial pacemaker wire. J Cardiovas Surg (Torino) 39:221-2.nGentry WH, Hassan AA. 1993. Complication of retained epicardial pacing wires: an unusual bronchial foreign body. Ann Thorac Surg 56:1391-3.nGundry SP, Sequeria A, Coughhir TR, et al. 1997. Postoperative conduction disturbances: a compression of blood and crystalloid cardioplegia. Ann Thorac Surg 63:901-2.nHodman RP, Starr A. 1969. Temporary post-operative epicardial pacing electrodes. Ann Thorc Surg 8:506-10.nKashima I, Aeba R, Katogi T, Kawada S. 2001. Optimal position of atrial epicardial leads for temporary pacing in infants after cardiac surgery. Ann Thorac Surg 71:1945-8.nMatwiyoff GN, McKinlay JR, Miller CH, Graham BS. 2000. Transepidermal migration of external cardiac pacing wire presenting as a cutaneous nodule. J Am Acad Dermatol 42:865-6.nMills NL, Ochsner JL. 1973. Experience with atrial pacemaker wires implanted during cardiac surgery. J Thorac Cardiovasc Surg 66:878-86.nPuskas JD, Williams WH, Duke PG, Stales JR, Glas KE, Marshall JJ. 2003. Off-pump coronary artery bypass grafting (OPCAB) provides complete revascularization while reducing myocardial injury, transfusion requirements and length of stay (LOS): a prospective randomized comparison of 200 unselected patients having OPCAB versus conventional CABG. J Thorac Cardiovasc Surg 125:797-808.nRaichlen JS, Campbell FW, Edie RN, Josephson ME, Harken AH. 1984. The effect of the site of placement of temporary epicardial pacemaker on ventricular function in patients undergoing cardiac surgery. Circulation 70:I118-23.nVitello-Cicciu JM, Brown MM, Lazar HL, McCabe C, McCormick JR, Roberts AJ. 1987. Profile of patients requiring the use of epicardial pacing wires after coronary artery bypass surgery. Heart Lung 16:301-5.nWaldo AL, MacLean WA, Cooper TB, Kouchoukos NT, Karp RB. 1978. Use of temporarily placed epicardial atrial wire electrodes for the diagnosis and treatment of cardiac arrhythmia following open heart surgery. J Thorac Cardiovasc Surg 76:500-5.nWexelman W, Lichstien E, Cunningham JN, et al. 1986. Etiology and clinical significance of new fascicular conduction defects following coronary artery bypass surgery. Am Heart J 111:925-7.n
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