Key result
Selective epicardial pacing wire placement cuts wire-related complications ~94% versus routine use.
Why the study?
Routine use of epicardial pacing wires after open-heart surgery is increasingly questioned due to potentially lethal complications and limited efficacy.
Does selective epicardial pacing wire placement reduce complications compared to routine placement in patients undergoing open-heart surgery?
RCT (n=237)
Single-blind (outcome assessors)
Randomly assigned
No
Does selective epicardial pacing wire placement reduce complications compared to routine placement in patients undergoing open-heart surgery?
Selective placement of epicardial pacing wires during open-heart surgery significantly reduces postoperative complications without increasing the need for active pacing or mortality compared to routine placement.
Supports caution with routine EPW use post-OHS; leaves open whether selective placement affects mortality in prospective trials.
Objective: Recently, the use of epicar-dial pacing wires (EPW) has become the standard of care for patients undergoing open-heart surgery (OHS) at many cardiovascular surgery centers. However, the routine use of EPWs after OHS is increasingly questioning due to their potentially lethal complications and limited efficacy. Here, we aimed to investigate the impact of EPW placement on in-hospital mortality and to compare the frequency of the EPW related complications in patients receiving routine or selective EPW placement after elective OHS. Methods: A total of 237 patients undergoing OHS in our clinic (ORDU UN¤VERSTY TRA¤N¤NG AND RESEARCH HOSP¤TAL) were enrolled in this study. Study subjects were randomly assigned to one of the groups: Routine or selective EPW placement. In the latter, EPWs were placed according to the presence of intraoperative bradycardia with hemodynamic compromise , nodal or junctional arrhythmias, atrioventri-cular block or ventricular tachycardia. Results: There were 95 patients (40 %) receiving routine EPW and 142 (60%) patients receiving selective EPW. Active pacing was performed or required in 13 patients (5.4%). Five of them were in routine EPW group and 8 were in the selective EPW group (p = 0.902). Active pacing requirement was similar in coronary artery bypass grafting and valvular surgery (5% vs. 9%, p = 0.712, respectively). Permanent pacing was required in any of the subjects. Complications related to EPW occurred in 17 patients receiving routine EPW and 2 patients receiving selective EPW (p < 0.001). Routine EPW implantation was significantly correlated with the development of the complications (r = 0.309, p <0.001). Conclusion: Our findings indicate that the number of patients requiring temporary pacing after OHS is quite low and implementing an EPW is associated with potentially hazardous complications. Selective EPW placement compared to routine EPW placement is associated with fewer postoperative complications.
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Emced Khalil (2019) conducted an RCT in Elective open-heart surgery (n=237). Selective epicardial pacing wire placement vs. Routine epicardial pacing wire placement was evaluated on EPW-related complications (p=<0.001). Selective epicardial pacing wire placement significantly reduced postoperative wire-related complications compared to routine placement (1% vs 18%, p < 0.001) in patients undergoing open-heart surgery.
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