Predictors for hemodynamic improvement with temporary pacing after pediatric cardiac surgery

Ceresnak, Scott R.; Pass, Robert H.; Starc, Thomas J.; Hordof, Allan J.; Bonney, William J.; Mosca, Ralph S.; Liberman, Leonardo

doi:10.1016/j.jtcvs.2010.03.048

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 1 , Pages 183-187, January 2011

Predictors for hemodynamic improvement with temporary pacing after pediatric cardiac surgery

Scott R. Ceresnak, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY
- Address for reprints: Scott R. Ceresnak, MD, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467.
Robert H. Pass, MD
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY
Thomas J. Starc, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY
Allan J. Hordof, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY
William J. Bonney, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY
Ralph S. Mosca, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY
Leonardo Liberman, MD
- Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital–Columbia, New York, NY

Received 25 June 2009; received in revised form 23 December 2009; accepted 16 March 2010. published online 26 July 2010.

Objectives

Temporary epicardial pacing wires are commonly placed during pediatric cardiac surgery. Data are sparse on postoperative pacing in this population. The objective of this study was to determine the frequency of use and identify predictors for the use of temporary epicardial pacing wires.

Methods

Perioperative data were prospectively collected on all patients who underwent cardiac surgery at our institution (n = 162).

Results

A total of 117 (72%) patients had temporary epicardial pacing wires placed. Postoperatively, 23 (20%) of 117 patients had hemodynamic improvement with the use of temporary epicardial pacing wires. Indications for pacing were slow junctional rhythm (11/23 [48%]), junctional ectopic tachycardia (7/23 [31%]), pace termination of supraventricular tachycardia (3/23 [13%]) and atrial flutter (1/23 [4%]), and complete heart block (1/23 [4%]). By using univariate analysis, single-ventricle anatomy, heterotaxy, the Fontan procedure, use of circulatory arrest, intraoperative arrhythmia, pacing in the operating room, and use of vasoactive medications were predictors for hemodynamic improvement with the use of temporary epicardial pacing wires (P < .05). On multivariate analysis, the Fontan procedure, circulatory arrest, and intraoperative arrhythmias were independent predictors (P < .01). When excluding all patients with any of these 3 risk factors, only 2% were paced. Patients with clinically significant pacing had longer chest tube drainage (P < .01) and intensive care unit length of stay (P < .01). There were no complications associated with temporary epicardial pacing wires.

Conclusions

The Fontan procedure, use of circulatory arrest, and intraoperative arrhythmias were associated with hemodynamic improvement with postoperative pacing and might represent indications for empiric intraoperative placement of temporary epicardial pacing wires. Patients without these risk factors were less likely to require pacing. Temporary epicardial pacing wires were safe and useful in the management of arrhythmias after pediatric cardiac surgery.

CTSNet classification: 20, 24

Abbreviations and Acronyms: CICU, cardiac intensive care unit, OR, odds ratio