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Congenital cardiac surgery without routine placement of wires for temporary pacing

Published online by Cambridge University Press:  31 October 2007

Steven B. Fishberger ,
Anthony F. Rossi ,
Juan M. Bolivar ,
Leo Lopez ,
Robert L. Hannan  and
Redmond P. Burke
Steven B. Fishberger*
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Anthony F. Rossi
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Juan M. Bolivar
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Leo Lopez
Affiliation:
Divisions of Cardiology, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Robert L. Hannan
Affiliation:
Divisions of Cardiothoracic Surgery, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
Redmond P. Burke
Affiliation:
Divisions of Cardiothoracic Surgery, Congenital Heart Institute, Miami Children’s Hospital, Miami, Florida, United States of America
*
Correspondence to: Steven B. Fishberger MD, Division of Cardiology, Miami Children’s Hospital, 3200 S.W. 60th Court, Miami, FL, 33155, USA. Tel: (305) 662 8301; Fax: (305) 662 8304; E-mail: steven.fishberger@mch.com
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Abstract

Objective

Temporary pacing wires have been associated with serious postoperative complications. Recommendations for their routine use after open heart surgery are decades old, and may not reflect current surgical techniques and outcomes.

Methods

The electronic web-enabled medical records of all patients undergoing congenital cardiac surgery from February, 2002, through December, 2005, were reviewed, excluding patients undergoing implantation of pacemakers as a primary procedure, or those undergoing ligation of a patent arterial duct.

Results

There were 1193 surgical procedures performed, 1041 with cardiopulmonary bypass. Median age of the patients was 5.8 months, with a range from 0 days to 54 years, weighing 6.2 kilograms, with a range from 1 to 114 kilograms. Mortality prior to discharge was 2.5%, and median postoperative stay was 6 days. No deaths were attributed to arrhythmias. Temporary pacing wires were placed 14 times (1.2%). Indications for placement included sinus nodal dysfunction in 8 patients, preoperative in 4 and intraoperative in 4, high degree atrioventricular block in 4 patients, and intraoperative atrial flutter in 2 patients. Of these patients, 4 (0.3%) eventually underwent permanent implantation of a pacemaker, 2 for persistent sinus nodal dysfunction, and 2 for persistent atrioventricular block. Postoperative junctional ectopic tachycardia requiring antiarrhythmic therapy occurred in 9 patients (0.8%). All recovered without incident, and none were treated with temporary pacing.

Conclusions

The diminished risk of unexpected postoperative arrhythmias in the current era alleviates the necessity for routine placement of temporary pacing wires. Those institutions with experienced surgical and cardiac critical care teams may be able to predict the need for temporary pacing wires preoperatively or intraoperatively.

Keywords

Paediatricsarrhythmiacardiac pacing
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 1 , February 2008 , pp. 96 - 99
Copyright
Copyright © Cambridge University Press 2008

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