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Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study

23 April 2020
Professional
02 April 2020
Volume 29 · Issue 8

Abstract

Background:

Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal.

Methods:

Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery.

Results:

Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge.

Conclusion:

Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.

Temporary epicardial pacing wires are routinely inserted after cardiac surgery (AlWaqfi et al, 2014) as postoperative arrhythmias are frequent in the cardiac surgery setting. The most frequently observed postoperative arrhythmias are supraventricular tachyarrhythmias, especially atrial fibrillation. Bradyarrhythmias are also frequently observed after cardiac surgery, due to conduction system trauma (Peretto et al, 2014).

The safety and efficacy of epicardial pacing wires have been accepted (Mishra et al, 2010). They allow emergency or therapeutic pacing, if required, after surgery. They remain in place for 24 hours to several days following surgery and are used to maintain heart rate and rhythm, which are necessary to optimise haemodynamics (AlWaqfi et al, 2014). Epicardial wires are manufactured with a small needle on one end. This is used to embed the wire in the myocardium, after which the needle is cut off. A larger needle on the other end of the wire is used to penetrate the body wall, bringing the wire to the surface.

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Cardiac surgery
Temporary pacing
Postoperative care
Practice improvement
Delayed discharge