title: Necessity of temporary epicardial pacing wires after surgery for congenital heart disease.
abstract: BACKGROUND
  Temporary epicardial pacing wires are commonly placed in patients undergoing surgery for congenital heart disease. Though often helpful, these wires are not without risk. We aimed to identify characteristics that would obviate placement of temporary epicardial pacing wires in this patient population.
  
  
  METHODS
  A prospective observational study was performed on patients admitted to the pediatric intensive care unit after surgery for congenital heart disease between October 2011 and October 2012. Logistic regression analysis was performed to identify independent predictors of patients in whom wires were not helpful postoperatively.
  
  
  RESULTS
  Wires were placed in 213 of 249 patients. Wires were helpful in 50 patients; 23 for diagnostic purposes only, 17 for therapeutic purposes only, and 10 for both. On logistic regression analysis, absence of intraoperative arrhythmias (p < 0.01), lower arteriovenous O2 difference (p < 0.01), and shorter duration of cardiopulmonary bypass (p = 0.050) were significant predictors of patients in whom wires were not helpful postoperatively. Further, the predicted probability based on logistic regression model using these 3 variables correctly identified 93% of patients who did not need pacing wires. Four complications (1.9%) related to wires occurred, including 1 episode of life-threatening bleeding that was found, during emergent exploration, to be due to atrial perforation at the wire insertion site.
  
  
  CONCLUSIONS
  Temporary epicardial pacing wires are not necessary in many patients recovering from surgery for congenital heart disease. A conservative approach to their use may therefore be warranted.
authors.affiliation: Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan. Electronic address: mchauhan@med.wayne.edu.
authors.forename: Monika
authors.initials: M
authors.lastname: Chauhan
authors.affiliation: Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Prentice
authors.affiliation: Department of Pediatrics, Children's Research Center of Michigan, Detroit, Michigan.
authors.forename: Marwan
authors.initials: M
authors.lastname: Zidan
authors.affiliation: Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Henry L
authors.initials: HL
authors.lastname: Walters
authors.affiliation: Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Delius
authors.affiliation: Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
mesh_terms: D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010101:Oxygen Consumption; D011446:Prospective Studies