Divisions of Pediatric Cardiology and Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia, New York, NY 10467, USA.
J Thorac Cardiovasc Surg. 2011 Jan;141(1):183-7. doi: 10.1016/j.jtcvs.2010.03.048. Epub 2010 Jul 24.
Temporary epicardial pacing wires are commonly placed during pediatric cardiac surgery. Data are sparse on postoperative pacing in this population. The objective of this study was to determine the frequency of use and identify predictors for the use of temporary epicardial pacing wires.
Perioperative data were prospectively collected on all patients who underwent cardiac surgery at our institution (n = 162).
A total of 117 (72%) patients had temporary epicardial pacing wires placed. Postoperatively, 23 (20%) of 117 patients had hemodynamic improvement with the use of temporary epicardial pacing wires. Indications for pacing were slow junctional rhythm (11/23 [48%]), junctional ectopic tachycardia (7/23 [31%]), pace termination of supraventricular tachycardia (3/23 [13%]) and atrial flutter (1/23 [4%]), and complete heart block (1/23 [4%]). By using univariate analysis, single-ventricle anatomy, heterotaxy, the Fontan procedure, use of circulatory arrest, intraoperative arrhythmia, pacing in the operating room, and use of vasoactive medications were predictors for hemodynamic improvement with the use of temporary epicardial pacing wires (P < .05). On multivariate analysis, the Fontan procedure, circulatory arrest, and intraoperative arrhythmias were independent predictors (P < .01). When excluding all patients with any of these 3 risk factors, only 2% were paced. Patients with clinically significant pacing had longer chest tube drainage (P < .01) and intensive care unit length of stay (P < .01). There were no complications associated with temporary epicardial pacing wires.
The Fontan procedure, use of circulatory arrest, and intraoperative arrhythmias were associated with hemodynamic improvement with postoperative pacing and might represent indications for empiric intraoperative placement of temporary epicardial pacing wires. Patients without these risk factors were less likely to require pacing. Temporary epicardial pacing wires were safe and useful in the management of arrhythmias after pediatric cardiac surgery.
在小儿心脏手术中，通常会放置临时心外膜起搏线。关于该人群术后起搏的数据很少。本研究的目的是确定临时心外膜起搏线的使用频率，并确定其使用的预测因素。
前瞻性收集我院所有接受心脏手术患者的围手术期数据（n=162）。
共有 117 例（72%）患者放置了临时心外膜起搏线。术后，117 例患者中有 23 例（20%）使用临时心外膜起搏线后血流动力学改善。起搏的指征为慢交界节律（11/23[48%]）、交界性异位心动过速（7/23[31%]）、室上性心动过速终止（3/23[13%]）和心房扑动（1/23[4%]）和完全性心脏阻滞（1/23[4%]）。通过单因素分析，单心室解剖结构、心脏异位、Fontan 手术、使用体外循环、术中心律失常、在手术室起搏以及使用血管活性药物是使用临时心外膜起搏线改善血流动力学的预测因素（P<0.05）。多因素分析显示，Fontan 手术、体外循环和术中心律失常是独立的预测因素（P<0.01）。当排除所有具有这 3 个危险因素的患者后，仅有 2%的患者需要起搏。有临床意义起搏的患者胸腔引流管放置时间更长（P<0.01），重症监护病房住院时间更长（P<0.01）。临时心外膜起搏线没有相关并发症。
Fontan 手术、使用体外循环和术中心律失常与术后起搏时血流动力学改善相关，可能代表术中放置临时心外膜起搏线的指征。无这些危险因素的患者不太可能需要起搏。临时心外膜起搏线在小儿心脏手术后心律失常的治疗中是安全且有效的。
