Indications for the use of pacing pulmonary artery catheters in cardiac surgery.
Several varieties of pulmonary artery catheters (PACs) with pacing capabilities are now available. Although specific recommendations for prophylactic perioperative placement of pacemakers have been offered previously, the authors believe that those recommendations warrant further examination, taking into consideration the availability of new pacing modalities. Toward this end, the use of pacing PACs in cardiac surgical patients was prospectively examined. In 600 consecutive adult patients with PACs placed prior to cardiopulmonary bypass (CPB), the cardiac anesthesiologist recorded if a pacing PAC was placed, the indications for placing it, and whether the catheter was used to pace. If a pacing PAC was not chosen, the anesthesiologist indicated whether cardiac pacing was needed prior to CPB. In all patients, the presence and specifics of the following five possible indications were documented: sinus node dysfunction/bradydysrhythmias, atrioventricular heart block, fascicular or bundle branch block, cardiac reoperation, and/or valvular heart disease. PACs with pacing capability were placed in 180 of the 600 patients (30.0%) and were used in 34 of these 180 patients (18.8%). In 4 of 420 patients (0.95%) without pacing PACs, cardiac pacing was needed prior to CPB. The following preoperative diagnoses were significant predictors (P less than .05) for the use or need for pacing catheters: sinus node dysfunction/bradydysrhythmias, a history of transient complete atrioventricular block, aortic stenosis, aortic insufficiency, and reoperation. The majority of adult patients undergoing cardiac surgery do not require the use of a pacing PAC prior to CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
Risk
S C
SC
Department of Anesthesia, Harvard Medical School, Boston, MA.
Brandon
D
D
D'Ambra
M N
MN
Koski
E G
EG
Hoffman
W J
WJ
Philbin
D M
DM
D000328:Adult; D001146:Arrhythmia, Sinus / Q000453:epidemiology / Q000628:therapy; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation*; D006327:Heart Block / Q000453:epidemiology / Q000628:therapy; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D011446:Prospective Studies; D012086:Reoperation