PREDICTION OF TEMPORARY EPICARDIAL PACING WIRE USE IN CARDIAC SURGERY

Abstract

Placement of temporary epicardial pacing wires (TEPW) at the end of open-heart surgery cases had been a routine practice for decades. While generally considered safe, there are complications with TEPW removal, mainly bleeding and tamponade, necessitating return to the operating room. There has been a trend toward omitting the placement of TEPW recently, given the risks of removal. Identification of which patients would be high risk of requiring pacing would be beneficial on deciding who needs TEPW placement. The purpose of this study was to identify predictors of requiring pacing immediately post cardiac surgery. A retrospective analysis of patients undergoing cardiac surgery from 2005-present at the Maritime Heart Center (MHC) was conducted. Data was obtained from the MHC clinical registry. Patients who required pacing on arrival to the cardiovascular intensive care unit (CVICU) were compared to those who were not paced on the basis of baseline and intraoperative characteristics. Multivariable logistic regression was used to determine risk adjusted likelihood of pacing for each variable. A total of 11752 patient underwent surgery from the year 2000-present. 2051 (17.5%) required pacing on arrival to CVICU vs. 9701 (82.5%) who did not. Patients who required pacing were more likely to be older (69.5 ± 10.7 vs. 65.0 ± 11.3, p < 0.01) and female (32% vs 25%, p < 0.01), had more comorbidities, and were less likely to undergo isolated CABG procedure (38.2% vs 61.2%, p < 0.01). After adjusting for age, sex and comorbidities, multivariable logistic regression showed older age, diabetes (OR 1.15, 95% CI 1.02-1.30, p=0.02), pre-op renal failure (OR 1.31, 95% CI 1.02-1.20, p < 0.01), class 4 New York Heart Association heart failure symptoms (OR 1.35, 95% CI 1.10-1.66, p < 0.01), pre-operative arrhythmia (OR 2.11, 95% CI 1.89-2.36, p < 0.01), calcium channel blocker use (OR 1.27, 95% CI 1.13-1.44, p < 0.01), and valve procedures (OR 1.83, 95% CI 1.56-2.14, p < 0.01) to be predictors of pacing on leaving the operating room. Identification of risk factors for pacing on arrival to CVICU will be useful in selective TEPW placement to avoid complications of TEPW. Future prospective studies on outcomes in patients in which TEPW were avoided will be needed to assess impact of selective TEPW placement.