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Ann Thorac Surg 1994;57:623-626
© 1994 The Society of Thoracic Surgeons

Articles

Pacing thresholds of temporary epicardial electrodes: Variation with electrode type, time, and epicardial position

Panny Kallis, FRCS*,1, Nicola Batrick, FRCS, Frank Bindi, FRCS, George Mascaro, MD, Andrew Chatzis, MD, Bruce E. Keogh, FRCS, D.John Parker, FRCS, Tom Treasure, FRCS

Cardiothoracic Unit, St. George's Hospital, London, England

Accepted for publication May 4, 1993.

* Address reprint requests to Mr Kallis, Department of Cardiothoracic Surgery, Harefield Hospital, Harefield, Middlesex UB9 6JH, England.

We compared the variation in pacing thresholds of two widely used temporary pacing electrodes at different epicardial sites in 67 patients after coronary artery operations performed with either cardioplegia or ventricular fibrillation. In 33 patients, a bare, braided pacing wire (DW) was placed on the right ventricle and a Medtronic localized epicardial electrode (MED), on each ventricle. In the other 34 patients, the DW wire was placed on the right atritum and a MED electrode, on each atrium. Pacing thresholds were measured at the time of placement; at 1 hour, 6 hours, and 12 hours postoperatively; and daily for 4 days. The pacing thresholds (mean ± standard error of the mean) at implantation were as follows: DW wire = 0.93 ± 0.08 V and MED electrode = 0.63 ± 0.1 V in the ventricles and DW = 1.28 ± 0.18 V and MED = 0.65 ± 0.09 V in the atria. On the fourth postoperative day, the pacing thresholds were DW = 2.08 ± 0.21 V and MED = 1.19 ± 0.22 V in the ventricles and DW = 2.33 ± 0.29 V and MED = 1.04 ± 0.09 V in the atria. The pacing thresholds of both types of wire increased significantly over time, but this deterioration was more pronounced with the braided wire both on the ventricle and on the atrium. The pacing threshold patterns were not affected by chamber side or mode of myocardial preservation. The braided ventricular wire failed to capture after 24 hours in 9 of 30 patients, whereas the localized epicardial electrode captured in all instances (p < 0.001). There was no significant difference in failure rate between the two wires in the atrial position. Localized epicardial electrodes have consistently lower pacing thresholds than braided wires in both the ventricles and the atria and are less prone to failure in the ventricular position.






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