title: Predictors for use of temporary epicardial pacing wires after pediatric cardiac surgery.
abstract: OBJECTIVE
  The objectives of this study were (1) to determine the use of temporary epicardial pacing wires to diagnose and treat early postoperative arrhythmias in pediatric cardiac surgical patients and (2) to determine the predictive factors for the need of pacing wires for diagnostic or therapeutic purposes.
  
  
  METHODS
  We collected preoperative, intraoperative, and postoperative data in a prospective, observational format from patients undergoing pediatric cardiac surgery between August 2010 and January 2011 at a single academic children's hospital.
  
  
  RESULTS
  A total of 157 patients met the inclusion criteria during the study period. Of these 157 patients, pacing wires were placed in 127 (81%). Pacing wires were used in 25 patients (19.6%) for diagnostic purposes, 26 patients (20.4%) for therapeutic purposes, 15 patients (11.8%) for both diagnostic and therapeutic purposes, and 36 patients (28.3%) for diagnostic or therapeutic purposes. Need for cardioversion in the operating room, presence of 2 or more intracardiac catheters, severely reduced ventricular ejection fraction, and elevated serum lactate level at the time of operating room discharge were found to be independent predictors for the use of pacing wires. The only complication noted in the cohort was a skin infection at a pacing wire insertion site in 1 patient. A permanent pacemaker was required in 8 (6.2%) of all patients with temporary pacing wires.
  
  
  CONCLUSIONS
  Our data support the use of temporary epicardial pacing wires in approximately 30% of children after congenital heart surgery. We found the need for cardioversion in the operating room, presence of 2 or more intracardiac catheters, severely reduced ventricular ejection fraction, and high serum lactate level at the time of discharge from the operating room to be independent predictors of the use of pacing wires in the early postoperative period.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, 1 Children’s Way, Slot 512-3, Little Rock, AR 72202-3591, USA. pgupta2@uams.edu
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.forename: Patricia
authors.initials: P
authors.lastname: Jines
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Mit
authors.initials: M
authors.lastname: Maurille
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
mesh_terms: D000046:Academic Medical Centers; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D002140:California; D006328:Cardiac Catheterization / Q000009:adverse effects; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004554:Electric Countershock / Q000009:adverse effects; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010496:Pericardium / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid