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Pediatric Cardiology

, Volume 40, Issue 3, pp 630–637 | Cite as

Selective Use of Temporary Epicardial Pacing Leads in Early Infancy Following Cardiac Surgery: Feasibility and Determinants of Clinical Application

  • Anastasios C. PolimenakosEmail author
  • Lauren Mathis
  • Brent Shafer
  • M. Vinayak Kamath
Original Article
  • 47 Downloads

Abstract

Use of temporary epicardial pacing (TEP) leads remains a routine perioperative strategy in congenital heart surgery. Selective use of TEP in neonates and infants undergoing cardiac intervention within the first 6 months of life has, yet, to be assessed. Outcome analysis was undertaken. From August 2014 to December 2016, 112 consecutive neonates and infants underwent cardiac intervention within the first 6 months of life. Patients with STS/EACTS Congenital Heart Surgery Mortality (STAT categories) 1–5 were prospectively followed from the index cardiac operation until hospital discharge and included in the study. Patients on permanent pacemaker (PPM) prior to the definitive cardiac intervention were excluded. Selective TEP placement was pursued if specific intraoperative indications were met. Determinants associated with the postoperative use of TEP were assessed. TEP leads were placed in 11 (9.8%) (GroupA). Nine was used for diagnostic and/or therapeutic purposes; two had no use (18%). From 101 patients without TEP (GroupB), one required treatment for postoperative dysrhythmia amenable to pacing. Vasoactive-inotrope score, ICU length of stay and time-to-negative balance was not statistically different between groups (p > 0.05). None of 112 patients required PPM insertion during hospital stay. Intraoperative need for cardioversion, attenuated ventricular function, and sustained sinus/AV node dysfunction or non-resolved elevated serum lactate at the time of operating room discharge were found to be predictors for TEP postoperative use. Selective placement of TEP leads is justified during early infancy for congenital heart surgery. Nearly 20% of those with TEP leads in place, even after its selective use, will not be required following surgery. Specific intraoperative parameters can guide the necessity and potential TEP postoperative use.

Keywords

Epicardial pacing leads Congenital heart surgery Outcomes 

Abbreviations

ACC

Aortic crossclamp

CPB

Cardiopulmonary bypass

CSD

Conduction system dysfunction

DVf

Function of dominant ventricle

ICULOS

ICU length of stay

MV

Mechanical ventilation

NSAIDs

Non-steroidal anti-inflammatory therapy

OR

Operating room

PPM

Permanent pacemaker

TIC

Transatrial intracardiac catheters

VIS

Vasoactive-inotropic score

Notes

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to report.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Need for parental consent was waived.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anastasios C. Polimenakos
    • 1
    • 2
    Email author
  • Lauren Mathis
    • 1
  • Brent Shafer
    • 1
    • 2
  • M. Vinayak Kamath
    • 2
  1. 1.Division of Pediatric Cardiothoracic Surgery, Children’s Hospital of Georgia Heart CenterMedical College of GeorgiaAugustaUSA
  2. 2.Department of SurgeryMedical College of GeorgiaAugustaUSA

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