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60 UTILITY AND SAFETY OF THE USE OF TEMPORARY PACING WIRES IN SURGERY FOR CONGENITAL HEART DISEASE
  1. C. S. Snyder1,
  2. G. L. Rosenthal1,
  3. J. M. Moltedo1
  1. 1Division of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans

Abstract

Background Arrhythmias are a frequent postoperative complication after congenital heart surgery. Many cardiac surgeons place temporary pacing wires (TPW) at the time of surgery. TPW are useful as they can be used to diagnose as well as treat the majority of post-operative arrhythmias. To date no study has evaluated their use or safety. The purpose of this study was to determine the utility and safety of TPW placed at the time of cardiovascular surgery (CVS).

Methods Single center, IRB approved, prospective observational study with data collected on all patients undergoing CVS from 09/00 to 03/03. Data included demographics, anatomy, arrhythmias, TPW placement, their use and all complications associated with their placement, use or removal.

Results 229 patients were enrolled, with 170 (74%) having TPW placed at time of CVS. TPW were utilized in 59 of 170 patients (35%). The TPWs were used in 33 patients for diagnostic purposes, 11 patients for therapeutic purposes and 15 for both diagnostic as well as therapeutic purposes. They were placed for a variety of CVSs, with the most common surgical procedure being repair of ventricular septal defects. Primary diagnostic reason for use was differentiation of sinus tachycardia from supraventricular tachycardia (19 patients.). The most common therapeutic reason was overdrive atrial pacing in junctional tachycardia (11 patients). Of the 59 patients without TPW, 0% required them during the postoperative period. TPW were removed at a mean of 5.5 days. No complications were observed related to their placement, use or removal. The surgeons predicted with 100% accuracy the patients that did not need TPW (59/59) and only 26% (59/170) of those who would require them. The 95% confidence interval around the estimate of true complication rate is 0-1.2%.

Conclusions Temporary pacing wires placed at the time of surgery for congenital heart disease are safe, with a zero percent complication rate, and effective in the diagnosis of arrhythmias in postoperative cardiac patients. The surgical team accurately predicted the patients that would not require them. Improvement in predictability of those that will use them could be made.

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