title: Cardiac tamponade after removal of temporary pacer wires.
abstract: BACKGROUND
  After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited.
  
  
  OBJECTIVE
  To determine risk factors for cardiac tamponade after temporary pacemaker wire removal.
  
  
  METHODS
  Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4).
  
  
  RESULTS
  Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes.
  
  
  CONCLUSIONS
  Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Ohio, USA. Mahonl@CCF.org
authors.forename: Linda
authors.initials: L
authors.lastname: Mahon
authors.forename: James F
authors.initials: JF
authors.lastname: Bena
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Morrison
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
mesh_terms: D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology; D002637:Chest Pain / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003430:Cross-Sectional Studies; D020878:Device Removal / Q000009:adverse effects*; D004244:Dizziness / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology; D006351:Heart Valves / Q000601:surgery; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D008297:Male; D009820:Ohio; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011182:Postoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013546:Sweating; D013610:Tachycardia / Q000453:epidemiology