PLACING EPICARDIAL PACING WIRES IN ISOLATED CORONARY ARTERY BYPASS GRAFT SURGERY–A PROCEDURE ROUTINELY DONE BUT RARELY BENEFICIAL
AbstractBackground: After Coronary Artery Bypass Graft (CABG) surgery, temporary epicardial pacing wiresare placed on heart to meet unforeseen complications like bradyarrhythmias or asystoles. This stepneeds additional time, resources and has potential to cause complication. Even having lesscomplications, is this additional step in elective CABG surgery necessary? Some important predictivefactors in patients who require this pacing wire placement have to be isolated. The objective of thestudy was to avoid this step if not required especially in elective CABG surgery. Methods: Thisprospective observational study involved 1047 consecutivepatients undergoing CABG at our institutionfrom 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 pacingpostoperatively 748 (97.1%), and Group B, who required pacing postoperatively 22 (2.9%). Bothgroups were compared in demographic, preoperative, per-operative and postoperative variables. Theincidence of pacing during the postoperative period was recorded. Predictors for postoperative pacingwere determined using medical records and the AFIC/NIHD cardiac surgery database. Results: In thepostoperative 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 frombypass (p=0.000) and use of antiarrhythmics on leaving the operating room (p=0.015) as predictors ofthe need for postoperative pacing. Diabetes, considered one of the major factor requiring pacing wasnot significant in our study (p=0.379). Preoperative arrhythmias, pacing utilized to separate frombypassand use of antiarrhythmics on leaving the operating room were found to be three most significant riskfactors. If the patients with any of these three risk factors are excluded, only 1.11% (8/716) of themwould have required pacing. Conclusions: Procedure of routine use of temporary epicardial pacingafter elective CABG surgery has negligible role, rather has additional cost and potential of rarecomplications. Diabetes is not a risk factor for post operative pacing.Keywords: Coronary artery bypass graft (CABG) surgery, arrhythmia, cardiac pacing
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