Key result
Selective TEPW strategies yield higher utilization and fewer unused wires than routine placement.
Why the study?
Routine temporary epicardial pacing wire placement in cardiac surgery is increasingly debated due to low utilization and potential procedural risks.
Does selective temporary epicardial pacing wire placement improve utilization and reduce unnecessary wire use compared to routine placement in patients undergoing cardiac surgery?
Does selective temporary epicardial pacing wire placement improve utilization and reduce unnecessary wire use compared to routine placement in patients undergoing cardiac surgery?
Selective placement of temporary epicardial pacing wires during cardiac surgery reduces unnecessary wire use and increases the utilization rate of placed wires compared to routine placement.
Selective strategies may reduce unused wires but should not yet change practice; leaves open need for RCTs to confirm outcomes.
Temporary epicardial pacing wires (TEPWs) are used widely for rhythm management in cardiac surgery. However, their routine placement is being debated increasingly because of low utilization and potential procedural risks. We compared routine versus selective TEPW placement practices and assessed the utilization, complications, and predictors of pacing need. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Cochrane Library until June 2025. Studies were included if they examined TEPW strategies in adult or pediatric cardiac surgery and reported outcomes related to wire use, complications, or predictors of pacing need. Eleven studies involving 16,874 patients (14,957 adults, 1,917 children) were included. Routine placement rates ranged from 73.5% to 89.9%, but utilization was low at 2.9%–29.6%. Selective strategies showed higher utilization of 30%–100% with fewer unused wires. Predictors of the need for TEPW included intraoperative arrhythmias, prolonged CPB, and complex procedures. Complications were rare. Thus, routine TEPW placement often leads to unnecessary wire use. Selective strategies based on intraoperative and clinical predictors may optimize patient care. Developing a risk-based tool could enhance decision-making and reduce procedural burden.
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Akele et al. (2026) conducted a review in Cardiac surgery (n=16,874). Routine temporary epicardial pacing wire (TEPW) placement vs. Selective TEPW placement was evaluated on Utilization, complications, and predictors of pacing need. Routine temporary epicardial pacing wire placement resulted in low utilization (2.9%–29.6%), whereas selective strategies yielded higher utilization (30%–100%) with fewer unused wires.
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