Diagnosis and Treatment of Cardiac Arrhythmias Following Open Heart Surgery: Emphasis on the Use of Atrial and Ventricular Epicardial Wire Electrodes

Abstract

Electrocardiographic recording from epicardial electrodes has provided new dimensions to the diagnosis of arrhythmias. The value of atrial electrograms, for instance, is here abundantly exemplified by atrial activity that is obscure on the surface ECG. The concept of diagnostic atrial is introduced to help distinguish automatic from nonautomatic rhythms, and ventricular arrhythmias from aberrant ventricular conduction. And, of course, these wires have made it very easy to assess atrioventricular conduction and sinus-node function. Perhaps more importantly, virtually all arrhythmias that follow open heart surgery are amenable to therapeutic cardiac pacing. (Four exceptions to this statement still exist: atrial and ventricular fibrillation, sinus tachycardia, and type II atrial flutter.) This text also covers all the circumstances in which temporary pacing offers distinct advantages over other therapeutic modalities. Examples include various times when direct current cardioversion may be hazardous, recurrent ventricular tachycardia, and drug-resistant classic atrial flutter. Finally, at least