Temporary atrial electrodes for diagnosis & treatment of post operative arrhythmias

Abstract

In a prospective study, the utility of atrial epicardial wire electrodes in the diagnosis and treatment of postoperative cardiac arrhythmias was evaluated. Atrial electrograms were recorded in 50 patients who underwent open heart surgery. In 9 patients, the atrial electrograms provided diagnostic information during 19 episodes of arrhythmias where the surface electrocardiogram was inconclusive. In 11 patients atrial electrograms provided accurate confirmation of the nature of the arrhythmia as suggested by the surface electrograms during 17 episodes of arrhythmias. Atrial pacing was used to effectively treat abnormalities of rhythm or conduction on 23 occasions. The epicardial wire electrodes were also utilised to evaluate sinus node functions at the bed side. Six patients had prolonged sinus and corrected sinus node recovery times (snrt, csnrt). Three of these also had prolongation of sinoatrial conduction time (sact). These parameters normalised in all within 2–3 weeks. Five of the six patients with sinus node dysfunction experienced significant post-operative arrhythmias. Their post-operative stay was also significantly prolonged till their sinus node function normalised. Thus atrial epicardial wires provide a simple, safe bedside technique for the accurate diagnosis and successful management of early postoperative arrhythmias following open heart surgery and also aid in the prognostic evaluation of patients susceptible to arrhythmias based on electrophysiologic evaluation of their sinus node functions.