Placing epicardial pacing wires in isolated coronary artery bypass graft surgery--a procedure routinely done but rarely beneficial.

BACKGROUND

After Coronary Artery Bypass Graft (CABG) surgery, temporary epicardial pacing wires are 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 consecutive patients 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 from bypass 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.