Incidence of tamponade following temporary epicardial pacing wire removal

Abstract

Background and Aim of Study Placement of temporary epicardial pacing wires (TEPW) is common practice in cardiac surgery. Removal of TEPW in the postoperative period can lead to serious bleeding necessitating surgical intervention and conferring high morbidity. The purpose of this study is to determine the incidence of TEPW removal complications. Methods A retrospective review of all major cardiac operations at our institution from 2005 to 2016 was conducted. Patients were identified using the Maritime Heart Center Database. We reviewed preoperative, intra‐operative, and postoperative characteristics of patients who returned to the operating room more than or equal to 3 days after their index operation to identify those who had bleeding and/or tamponade as a consequence of TEPW removal and any subsequent morbidity. Results A total of 11 754 patients underwent cardiac surgery at our institution between 2005 and 2016. Of these patients, 88 (0.75%) went back to the operating theater for bleeding and/or tamponade more than or equal to 3 days from their initial index operation. Of these, 11 (0.09%) were secondary to TEPW removal where two (0.017%) suffered irreversible anoxic brain injury. All 11 patients were on antiplatelet therapy with the addition of either deep venous thrombosis (DVT) prophylaxis or therapeutic anticoagulation, which is the standard of care at our institution. Conclusions Bleeding complications following TEPW removal are rare but have significant consequences including increased hospital length of stay, resource utilization, and morbidity. Standardized practice to address antiplatelet, DVT prophylaxis, and anticoagulation before removal may help further reduce the incidence of serious bleeding events.

Rare Intra-Aortic Migration of Temporary Epicardial Pacing Wire

“…But, occasionally, these wires are not removed and clipped close to the skin level, if any resistance is found on its removal as catastrophic complications can occur on its forced removal like coronary artery bypass graft injuries, cardiac arrhythmias, and pericardial or cardiac wall injuries leading to cardiac tamponade. 3 4 …”

Prediction of temporary epicardial pacing wire use in cardiac surgery

“…TEPW have been shown to have complications from their placement and removal, the most serious complication being bleeding and tamponade, with the incidence being 9.7 to 18 per 10 000 patients 6‐8 . Similarly, cutting TEPW and leaving them to retract internally can result in long term morbidity in rare cases, such as embolization and migration over a period as early as 1 year and as late as 24 years following placement 9,19‐24 …”

“…Placement of temporary epicardial pacing wires (TEPW) is routine practice in cardiac surgery 1 . While used routinely for all cases in many centers, some practices report selective use of TEPW in patients at high risk for bradyarrhythmias 2,3 due to concerns of complications with either TEPW placement, 4 removal, 5‐8 or due to cutting TEPW and leaving them to retract internally 9 …”

Complications of Epicardial Pacing Wire Removal Following Adult Cardiac Surgery: A Systematic Review

“…Notably, two of the tamponade patients sustained irreparable anoxic brain injury. All 11 patients were on antiplatelet therapy and/or anticoagulation, which is the institution's standard of care [ 7 ]. However, post-epicardial pacing wire removal arrhythmia was the only complication observed in the study.…”