Predictors of temporary epicardial pacing wires use after valve surgery

BACKGROUND: Although temporary cardiac pacing is infrequently needed, temporary epicardial pacing wires are routinely inserted after valve surgery. As they are associated with infrequent, but life threatening complications, and the decreased need for postoperative pacing in a group of low risk patients; this study aims to identify the predictors of temporary cardiac pacing after valve surgery. METHODS: A retrospective analysis of data collected prospectively on 400 consecutive valve surgery patients between May 2002 and December 2012 was performed. Patients were grouped according to avoidance or insertion of temporary pacing wires, and were further subdivided according to temporary cardiac pacing need. Multiple logistic regression was used to determine the predictors of temporary cardiac pacing. RESULTS: 170 (42.5%) patients did not have insertion of temporary pacing wires and none of them needed temporary pacing. 230 (57.5%) patients had insertion of temporary pacing wires and among these, only 55 (23.9%) required temporary pacing who were compared with the remaining 175 (76.1%) patients in the main analysis. The determinants of temporary cardiac pacing (adjusted odds ratios; 95% confidence interval) were as follows: increased age (1.1; 1.1, 1.3, p=0.002), New York Heart Association class III- IV (5.6; 1.6, 20.2, p=0.008) , pulmonary artery pressure ≥ 50 mmHg (22.0; 3.4, 142.7, p=0.01), digoxin use (8.0; 1.3, 48.8, p=0.024), multiple valve surgery (13.5; 1.5, 124.0, p=0.021), aorta cross clamp time ≥ 60 minutes (7.8; 1.6, 37.2, p=0.010), and valve annulus calcification (7.9; 2.0, 31.7, p=0.003). CONCLUSION: Although limited by sample size, the present results suggest that routine use of temporary epicardial pacing wires after valve surgery is only necessary for high risk patients. Preoperative identification and aggressive management of predictors of temporary cardiac pacing and the possible modulation of intraoperative techniques can decrease the need of temporary cardiac pacing. Prospective randomized controlled studies on a larger number of patients are necessary to draw solid conclusions regarding the selective use of temporary epicardial pacing wires in valve surgery.