Optimal Location for Temporary Epicardial Pacing Leads Following Open Heart Surgery

Abstract

Temporary epicardial pacing wires are routinely placed in patients undergoing cardiac surgery. Eighteen suitable patients undergoing elective surgery were prospectively studied. Their sensing and stimulating characteristics were studied at various locations. Subepicardial pacing leads were applied to the lateral wall of the LV, apex of the LV, anterior wall of the RV, diaphragmatic wall of the RV, and diaphragmatic wall of the LV. Impedance, R wave amplitude, slew rate, and stimulation thresholds were measured on postoperative days 1 and 5. Impedance remained unchanged in time with no significant differences between locations. R waves and slew rates were significantly lower in the anterior RV wall. Stimulation thresholds displayed no differences on day 1, but they increased significantly in all locations on day 5. These thresholds were significantly lower in the lateral and diaphragmatic LV walls on day 5, and the rate of voltage increase was also lower in these two locations. Five patients presented phrenic nerve stimulation when stimulating the lateral LV wall. The authors advocate the diaphragmatic wall of the LV as the best location for placing temporary leads. The anterior wall of the RV is not recommended for pacing purposes.

How Close Are the Phrenic Nerves to Cardiac Structures? Implications for Cardiac Interventionalists

“…28 On balance, the best location for achieving most effect must be weighed up against increased risk of trauma to important cardiac and extracardiac structures. 28,29…”

Entraînement électrosystolique épicardique temporaire post-chirurgie cardiaque : modalités pratiques

“…Certains sites sont responsables d'un meilleur profil hé modynamique, alors que d'autres pré servent la longé vité des é lectrodes [13]. La fragilité des tissus myocardiques est é galement à prendre en compte, surtout chez les patients âgé s, pour é viter le saignement abondant lors de l'ablation et le risque de tamponnade.…”

Is Electrode Catheter Ablation‐Induced Phrenic Nerve Injury Really a Benign Condition?

“…Meanwhile, the left phrenic nerve has a proximity to the lateral vein, great cardiac vein, left atrial appendage, and the lateral wall of the left ventricle 10 . ECA or pacing close to these areas may also cause PNI 3,4,12 . Nevertheless, as differential patterns of innervation have been noted in the human heart, 10,13 cautions should be taken while attempting ECA even in areas other than those described above.…”

“…10 ECA or pacing close to these areas may also cause PNI. 3,4,12 Nevertheless, as differential patterns of innervation have been noted in the human heart, 10,13 cautions should be taken while attempting ECA even in areas other than those described above. Furthermore, newer ECA systems designed for AF ablation for circumferential delivery of energy around the pulmonary vein orifices may increase the incidence of PNI.…”