Temporary Epicardial Pacing After Valve Replacement: Incidence And Predictors

Abstract

Temporary pacemaker wires are usually inserted in patients after valve replacement and may be beneficial for optimizing myocardial function in patients that develop postoperative hemodynamically significant arrhythmias [Elmi 2002]. Indications for temporary cardiac pacing (TCP) are atrial, ventricular or atrioventricular pacing for bradyarrhythmias and for management of both atrial and ventricular tachyarrhythmias [De Belder 1990; Liebold 1998].Pacemaker wires have two ends – one end has a small needle, which is passed into the myocardial surface, then is cut off. The needles may be coiled or clipped for better fixation. On the other end, the larger needle is used to penetrate the body wall, to pass the wire through to the body surface. There is debate about the ideal site for wire insertion, with agreement that the most common site of insertion is in the right ventricle [Hurle 2002]. The complications of PMWs include: bleeding, tamponade, arrhythmias, and even retention with its serious hazards [Kapoor 2011; Smith 2013]. During removal of PMWs, there may be atrial or ventricular lacerations which lead to bleeding and to developing tamponade. This may prolong the hospital stay of patients, especially patients on anticoagulant medications. This study was done on patients who received pacing wires during cardiac surgery. The purpose of the study was to predict risk factors that could lead to cardiac pacing after valve surgery.