N Kiely1; M Mooney2; F O'Brien2; V Young1;
1 St James's Hospital, Ireland; 2 Trinity College Dublin, Ireland
ObjectiveTo determine the percentage of patients who use epicardial pacing wires which are inserted after cardiac surgery. Also to determine complications including delayed removal.
MethodData was collected prospectively for all cardiac surgical patients over a 5 month period. Demographic data, operative procedure and detail relating to pacing wires were recorded.
ResultsPacing wires were inserted in 164 of 167 patients having cardiac surgery. Of these, the majority (74%) of patients did not require pacing at any stage. Patients were further divided into those who had AVR as a component of their operation (42) and those who did not (122).
Of those having AVR 26% (11) used their wires, including 9% (4) who went on to permanent pacemaker. 50% (21) of this group had their epicardial wires removed by day 4.
Of the non AVR patients, 23% (28) used their wires. Permanent pacemaker happened only in the context of tricuspid valve replacement for 2 patients. Of the non AVR patients who required temporary post-operative pacing, 18 were paced for less than 12 hours. 2 were paced for 1 day post op; 4 were paced for 2 days. 0 for 3 days and 2 for 4 days, none of this group required temporary pacing beyond 4 days post op. 54% (66) had their wires out by day 4.
The standard protocol in the research site is for unused pacing wires to be removed on day 4 post operatively but not to remove wires on weekends. 53% (87) of all cases had wires removed by day 4. 18% (29) had wires removed on day 5, 17% (28) on day 6 and 10% (16) had wires removed after day 7. A small number of patients died with pacing wires in situ (n=4; 2.4%) and a small number (n=3; 1.8%) were delayed as anticoagulation had to be stopped prior to wire removal. There were no pacing wire related complications apart from delayed discharge.
ConclusionThe majority of patients having pacing wires did not require pacing and wire removal was uncomplicated in this study. The policy in this centre not to remove pacing wires on weekends delayed discharge for a significant number of patients.