Publication:

Prospective analysis of pacing requirements following cardiac surgery

Background Post-operative conduction abnormalities are one of the complications occur after cardiac surgery, which can occasionally lead to significant morbidity and mortality. Conduction abnormalities can occur during and immediately after cardiac surgery, most commonly in valve operations. Possible mechanisms include injury to conduction apparatus during decalcification, injury from the sutures, needles and post-operative edema around the conduction system due to injury to surrounding tissues. Most of the pacing requirement is often temporary with only a small proportion of patients requiring permanent pacing. This study was conducted to study incidence of pacing requirements following cardiac surgery and to identify possible risk factors contributing to post-operative cardiac pacing.

Methods In this study, all relevant data are collected from patients who met the criteria for the study which includes pre-operatively relevant history and routine investigations were done. Intra-operative data were collected and post-operatively – routine blood and cardiac investigations were done on the day of surgery and on alternate days thereafter. The onset of new arrhythmias and the need for pacing are recorded.

Results In this study, of 350 patients who underwent various types of cardiac surgeries, only 79 (22.6%) patients required temporary pacing of the heart with the temporary pacing wire. Of these, only 1 (0.29%) patient was pacing dependent and requiring permanent pacemaker implantation.

Conclusions In the study, the factors predicting post-operative pacing requirement were the presence of pre-operative atrial fibrillation, moderate to severe calcification of valves, surgeries performed using cardiopulmonary bypass with prolonged aortic cross-clamp time.