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Ann Thorac Surg 2006;82:1493
© 2006 The Society of Thoracic Surgeons
Cardiothoracic Surgery, The Childrens Hospital, 1056 E 19th Ave, Denver, CO 80218
(Email: clarke.david{at}tchden.org).
The study described in the article by Narita and colleagues [1] compares the use of biodegradable film attachment of temporary pacing wires to the surface epicardium with leads attached in a conventional fashion by suturing into the myocardium. Unipolar ventricular pacing was used in both groups of animals, and pacing performance values were measured serially to postoperative day 14, when the wires were removed. Although there were some differences in the values measured, both groups exhibited very satisfactory performance. Several animals in the sutured lead group had ventricular arrhythmias upon removal, but no other complications occurred in either group.
Even though the concept of sutureless temporary pacing wires is appealing, there are some concerns about this evaluation that should be addressed. The first is that the wires were left in place for 14 days in all animals. In the clinical setting, wires are often removed within the first few days after surgery. If ease of removal is partially dependent on the film biodegrading, earlier removal could be more dangerous.
Much of cardiac surgery today involves reoperation, often leading to significant epicardial scar. Establishing adequate contact without penetrating the surface of these hearts might prove to be difficult. Although the authors indicate that one of the animals had been operated on previously and that the performance of the lead in that case was not different, it seems that this question deserves a closer look.
The article briefly mentions using this method to attach wires to the atria and their safe removal; however, no details were provided. It is conceivable that the adherence of the film might tear the thin atrial wall, especially if removal was attempted early postoperatively.
Finally, the 30-mm size of the circular patch used in this study may limit its utility. It certainly would make bipolar pacing a problem in the pediatric patient, and the use of this method in infants could possibly exacerbate diastolic dysfunction by inhibiting the distensibility of a small ventricle. Perhaps a smaller patch could be developed and tested.
The use of biodegradable film to attach temporary pacing wires to the epicardium is a novel concept that may have value. It appears, however, that more investigation of this method is needed before its widespread use for possible prevention of a very rare complication can be recommended.
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