Table 1 General view of the pacing incidence after open-heart surgical procedures, primary reasons for postoperative pacing and study conclusions. None of the studies reported of complications to the use of temporary pacemaker electrodes
From: Risk and benefits of temporary pacemaker electrodes in adult open-heart surgery—a systematic review
Study | Study design | Type of surgery | Total no. of patient | No of patient having temporary pacemaker electrodes inserted | No. of patients requiring temporary pacing | Primary reasons for pacing (no. of patients) | Conclusion |
|---|---|---|---|---|---|---|---|
Cote CL, Baghaffar A, “Prediction of temporary epicardial pacing wire use in cardiac surgery”, 2020 | Retrospective observational study | CABGa, valve replacement, valve repair | 11.752 | 11.752 | 2.051 (18%) | Not reported | “This study identified older age, female sex, pre- operative renal failure, lower EF, preoperative arrhythmia and preoperative use of calcium channel blockers, longer cross-clamp time and non-CABG to be predictive of pacing” |
Kiely N, “Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study”, 2020 | Prospective cross-sectional study | CABG, valve replacement, valve repair, and other procedures | 167 | 164 | 41 (24%) | Not reported | “Most patients in this study did not require postoperative pacing” |
Abd Elaziz ME, “Temporary epicardial pacing after valve replacement: incidence and predictors”, 2018 | Retrospective observational study | Valve replacement | 90 | 60 | 12 (20%) | AVBb (67%), sinus bradycardia (8%), asystole (8%), low cardiac output (17%) | “It also showed little need for pacing in many cases, especially with proper selection of patient characteristics that lower the use of pacing wires” |
Alwaqfi, “Predictors of temporary epicardial pacing wires use after valve surgery”, 2014 | Retrospective observational study | Valve surgery | 400 | 230 | 55 (24%) | AVB (46%), nodal/junctional rhythms (15%), low cardiac output (24%), sinus bradycardia (9%), asystole (7%) | “Routine use of PWsc after valve surgery is necessary for high risk patients” |
Khorsandi M., “Is it worth placing ventricular pacing wires in all patients post-coronary artery bypass grafting?”, 2012 | Systematic review | CABG | 7.643 (10 publications) | Not reported | Not reported | AVB (2%) | “Routine ventricular pacing wire insertion post-CABG is unnecessary given that routine use of ventricular wires can occasionally cause complications” |
Ferrari AD, “Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution”, 2011 | Retrospective observational study | Valve replacement, valve replacement + CABG surgery | 1.102 | Not reported, assumed 1.102 | 187 (17%) | Not reported | “This work highlights the risk factors associated with the development of AVB in the post-cardiac surgery valve and the need for temporary cardiac pacing” |
Asghar M. I., “Placing epicardial pacing wires in isolated coronary artery bypass graft surgery - A procedure routinely done but rarely beneficial”, 2009 | Prospective observational study | CABG | 1.047 | 770 | 22 (3%) | Sinus bradycardia (64%), AVB (9%), bundle branch block (18%), cardiac arrest (9%), | “Procedure of routine use of temporary epicardial pacing after elective CABG surgery has negligible role, rather has additional cost and potential of rare complications” |
Imren Y., Benson AA, “Is the use of temporary pacing wires following coronary bypass surgery really necessary?”, 2008 | Prospective observational study | CABG | 564 | 20* (pacewires were inserted if one or more of the criteria were present intraoperatively: sinus bradycardia, sinus arrest, nodal/junctional rhythms, AVB, BBBd, ventricular tachycardia, or atrial fibrillation) * (31/296 in total of which 11/268 OPCAP) | 20 (100%) (exclusion criteria were the existence of preoperative arrhythmias (BBB, VFe, AVB, AFf) or permanent pacemaker) | Sinus bradycardia (52%), nodal/junctional rhythms (16%), AVB (13%), atrial fibrillation (13%), BBB (7%) (eeported in the abstract) | “Temporary epicardial pacing wire implantation is overused in cardiac surgery and identifying independent predictors for pacing we conclude that temporary epicardial pacing wires should be limited to a select few”. |
Bethea BT, Salazar JD, “Determining the utility of temporary pacing wires after coronary artery bypass surgery”, 2005 | Prospective observational study | CABG | 222 | 222 | 19 (9%) | Sinus bradycardia (32%), AVB (21%), atrial fibrillation (16%), BBB (16%), asystole (5%), unknown (11%) | “Few patients require temporary epicardial pacing after routine CABG” |
JD Puskas, “Is routine use of temporary epicardial pacing wires necessary after either OPCAB or conventional CABG/CPB”, 2003 | Prospective study | CABG, CPBg | 197 | 33* (pacewires were inserted if epicardial pacing was required at the time of chest closure) | 23 (70%) | Sinus bradycardia (30%), low cardiac output (30%), nodal or junctional rhythms (6%), AVB (18%) | “Need for pacing immediately prior to chest closure accurately and safely identifies coronary patients who will require postoperative pacing after OPCABh or CABG/CPB. Routine use of temporary epicardial pacing pacing wires is unnecessary.” |
Takeda, M.; “Use of temporary atrial pacing in management of patients after cardiac surgery”, 1996 | Retrospective observational study | Congenital heart disease, coronary artery disease, valvular heart disease, miscellaneous disorders | 339 | 339 | 186 (55%) | Supraventricular bradycardia (82%), bradycardic atrial fibrillation (13%), AVB (10%), premature beat (21%), atrial filter or paroxysmal supraventricular tachycardia (11%) | “Temporary atrial pacing after cardiac surgery is useful for many purposes […] the authors believe that it should be applied in preference to pharmacological treatment” |
Morin JE., “Temporary cardiac pacing following open-heart surgery”, 1982 | Prospective observational study | Aortocoronary by-pass grafting, aortic valve replacement, CABG, aortocoronary bypass grafting + other procedures | 100 | 65 | 23 (35%) | Junctional or nodal rhythm (42%), sinus bradycardia (33%), sinus arrest (13%), AVB (8%), ventricular tachycardia (4%) | “Temporary pacemaker wires should always be implanted in patients after they have undergone open-heart surgery, especially when abnormal rhythms are present, or the cross-clamping time is prolonged and when larger volumes of cardioplegic agent have been used” |