M. M. Kamal1, M. Usman1, A. Ahad1, A. A. Hussain1, S. Hashmi1, M. Mehdi1, M. Munir1, H. Sharif1 1Aga Khan University Medical College, Cardiothoracic, Karachi, Sindh, Pakistan
Introduction:
Temporary Epicardial Pacing Wires (TEPWs) are routinely placed in Coronary Artery Bypass Graft surgery (CABG) to treat unforeseen post-operative arrhythmias. The practice is however controversial due to catastrophic complications associated with its use. This study aims to determine the frequency of TEPWs use postoperatively, associated complications and predictors of their use in order to limit the routine and non-selective placement of TEPWs in CABG.
Methods:
This single sample longitudinal study involved 322 consecutive patients who underwent isolated CABG in the department of Cardiothoracic Surgery, Aga Khan University Hospital Karachi, from September 2019 to August 2020. Demographic, peri operative and outcome variables i.e. post-operative TEPWs use were extracted from patients files and electronic database. Independent t-test and chi-squared test were applied for descriptive analysis. Univariate and multivariate logistic regression models were also built to explore predictors of TEPWs use in the sampled population
Results:
A total of 322 isolated CABG patients were analysed, where only 27 (8.4%) patients required TEPWs. Mean age of the patients requiring and not requiring TEPWs was 66.3 ± 8.9 vs 58.7 ± 8.9, p<0.001 and ejection fraction (%) was 44.1 ± 12.8 vs 48.9 ± 12.8 p=0.032 respectively. After adjusting for clinically plausible demographics and perioperative variables, increasing age and low Ejection fraction % were found to be significantly associated with the use of TEPW in post-operative period of isolated CABG patients. No complication of TEPWs were recorded in our study. Three patients out of 27 required permanent pacemaker due to complete heart block.
Conclusion:
As use of TEPWs in the post-operative period is low hence routine placement of temporary epicardial pacing wires in isolated CABG should be discouraged and only preferred in patients who will need them, such as patients with increased age or a low left ventricular Ejection fraction. TEPWs use is likely to increase by 9% and 5% with each increase in age year and each decrease of EF respectively. Hence, TEPWs’ use should be case-specific in isolated CABG patients. Such approach will not only decrease the cost of surgery but also prevent life threatening complications associated with TEPWs.