PLACING EPICARDIAL PACING WIRES IN ISOLATED CORONARY ARTERY BYPASS GRAFT SURGERY-A PROCEDURE ROUTINELY DONE BUT RARELY BENEFICIAL
Abstract
Background: After Coronary Artery Bypass Graft (CABG) surgery, temporary epicardial pacing wiresare placed on heart to meet unforeseen complications like bradyarrhythmias or asystoles. This step
needs additional time, resources and has potential to cause complication. Even having less
complications, is this additional step in elective CABG surgery necessary? Some important predictive
factors in patients who require this pacing wire placement have to be isolated. The objective of the
study was to avoid this step if not required especially in elective CABG surgery. Methods: This
prospective observational study involved 1047 consecutivepatients undergoing CABG at our institution
from May 2006 to April 2008. Patient who did not receive pacing wire (230), Preoperative pacemaker
(2), CABG with valvular surgery (10), CABG with Ischemic VSD or MR surgery (3), off-pump CABG
(21), or incomplete follow-up (11) were excluded from the study. Patients who received pacing wire
(770) were divided in two groups. Group A, consisted of patients who did not require pacing
postoperatively 748 (97.1%), and Group B, who required pacing postoperatively 22 (2.9%). Both
groups were compared in demographic, preoperative, per-operative and postoperative variables. The
incidence of pacing during the postoperative period was recorded. Predictors for postoperative pacing
were determined using medical records and the AFIC/NIHD cardiac surgery database. Results: In the
postoperative period, 22 of 770 patients (2.9%) required pacing. Analysis identified age (p=0.02),
preoperative arrhythmia, especially Bundle Branch Block (p=0.000), pacing utilized at separation from
bypass (p=0.000) and use of antiarrhythmics on leaving the operating room (p=0.015) as predictors of
the need for postoperative pacing. Diabetes, considered one of the major factor requiring pacing was
not significant in our study (p=0.379). Preoperative arrhythmias, pacing utilized to separate frombypass
and use of antiarrhythmics on leaving the operating room were found to be three most significant risk
factors. If the patients with any of these three risk factors are excluded, only 1.11% (8/716) of them
would have required pacing. Conclusions: Procedure of routine use of temporary epicardial pacing
after elective CABG surgery has negligible role, rather has additional cost and potential of rare
complications. Diabetes is not a risk factor for post operative pacing.
Keywords: Coronary artery bypass graft (CABG) surgery, arrhythmia, cardiac pacing
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