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Ann Thorac Surg 2005;79:1387
© 2005 The Society of Thoracic Surgeons

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New technology

INVITED COMMENTARY

Texas Tech University Health Sciences Center, 3601 4th St, MS 8312, Suite 3A159, Lubbock, TX 79430–8001

(E-mail: ari.halldorsson{at}ttmc.ttuhsc.edu).

Placement of temporary atrial and ventricular pacing wires after cardiac surgery continues to be the standard of care. The ideal temporary pacing wire must sense and pace reliably throughout the postoperative period, both in the atrial and ventricular positions, be easily placed and removed, and without significant risk of complications or discomfort to the patient. As none of the currently used temporary pacing wires have been found to be clearly superior to another, most cardiac surgeons use wires and insertion methods they are comfortable with and have found to be reliable.

The authors of this paper evaluated a new type of temporary bipolar pacing lead. As the study had a relatively small patient population and no control group, conclusions have to be drawn very carefully. The failure rate, both sensing and pacing, and the dislodgement rate were high compared to similar studies using different wire types. This is especially alarming when taken into account that only one lead is placed in the atria and the ventricle, so when a lead dislodges or fails there is no second temporary pacing wire that can be used to salvage the function by placing a grounding wire in the skin. Since one of the proposed advantages of these leads is that only one has to be used in each position, they should ideally be more reliable than the most commonly used unipolar pacing wires. The rate of diaphragmatic pacing was also surprisingly high, considering that it is an exceedingly uncommon complication with currently used temporary pacing wires. Although these leads are described as easy to use, few mentions are made of adjustment in insertion techniques, which suggests that placing all the noninsulated portion of the leads within the muscle requires some practice. Major complications such as bleeding after removal would require a much larger patient population to detect.

In summary, the authors have shown that this single bipolar atrial and ventricular temporary pacing wire can be used after cardiac surgery with relative ease and low risk of complications. The failure rate is at the higher end of acceptable. To conclusively compare the pros and cons of this lead to the currently used temporary pacing wires would require a much larger randomized prospective study.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Halldorsson, A. Search for Related Content PubMed Articles by Halldorsson, A. Related Collections Electrophysiology - arrhythmias