Determining the utility of temporary pacing wires after coronary artery bypass surgery.
BACKGROUND
Temporary epicardial pacing wires are used routinely after coronary artery bypass graft (CABG) surgery and can cause rare, catastrophic complications. This study's purpose was to identify patient characteristics predicting the need for pacing after CABG surgery with the potential to limit their utilization.


METHODS
This prospective observational study involved 290 consecutive patients undergoing CABG at our institution from August 2000 to January 2001. Sixty-eight patients were excluded for the following reasons: off-pump CABG, preoperative pacemaker, no pacing wire placement, or incomplete follow-up. Among the remaining 222 patients, the incidence of pacing during the postoperative period was recorded. Univariate and independent multivariate predictors for postoperative pacing were determined using medical records, the Johns Hopkins Hospital cardiac surgery database and the Society of Thoracic Surgery database.


RESULTS
In the postoperative period, 19 of 222 patients (8.6%) required pacing. Univariate analysis identified age, cardiomegaly, preoperative antiarrhythmic therapy, diabetes mellitus, preoperative arrhythmia, inotropic agents leaving the operating room, and pacing initialized at the separation from cardiopulmonary bypass as predictors of the need for postoperative pacing. Only diabetes mellitus, preoperative arrhythmia, and pacing utilized to separate from bypass were found to be significant on multivariate analysis. Using this model, if we exclude the patients with any of these three risk factors, only 2.6% of them would have required pacing.


CONCLUSIONS
Few patients require temporary epicardial pacing after routine CABG. This study identified specific predictors for postoperative pacing requirements and provides criteria for the selective use of epicardial pacing wires after CABG.
Bethea
Brian T
BT
Division of Cardiac Surgery, The Johns Hopkins Medical Institution, Baltimore, Maryland, USA.
Salazar
Jorge D
JD
Grega
Maura A
MA
Doty
John R
JR
Fitton
Torin P
TP
Alejo
Diane E
DE
Borowicz
Louis M
LM
Gott
Vincent L
VL
Sussman
Marc S
MS
Baumgartner
William A
WA
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D015897:Comorbidity; D001026:Coronary Artery Bypass; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors