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Feasibility of customised unipolar conversion using bipolar temporary pacing wires in patients after surgical repair of congenital heart disease

Published online by Cambridge University Press:  20 August 2013

Bjoern Peters ,
Oliver Miera ,
Peter Ewert ,
Sevim Yilmaz ,
Felix Berger  and
Boris Schmitt
Bjoern Peters*
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Oliver Miera
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Peter Ewert
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Sevim Yilmaz
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Felix Berger
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Boris Schmitt
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
*
Correspondence to: B. Peters, MD, Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 45932800; Fax: +49 30 45932900; E-mail: [email protected]
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Abstract

Objective: Temporary pacing wires play a crucial role in the diagnosis and therapy of post-operative arrhythmia after surgery for congenital heart disease. At present, bipolar pacing wires are used in most institutions. In case of functional failure of these wires, a unipolar mode of stimulation and sensing should be theoretically possible as a rescue procedure. Methods: We tested the feasibility of the customised unipolar mode in 18 post-operative patients with congenital heart disease (age 9.2 ± 13.9 months, weight 6.3 ± 3.8 kg, and cardiopulmonary bypass time 70 ± 29 minutes). As there are two possible unipolar configurations, there are twice the number of testing parameters; of those, we compared sensing (mV) and pacing thresholds (V at 0.5 ms). Results: Atrial sensing was significantly better in the unipolar modes (p < 0.001, p < 0.003). The ventricular unipolar sensing did not differ significantly in the “better” of the two possible configurations from the bipolar values (p = 0.363). For the unipolar pacing thresholds, only the “better” unipolar configuration did not differ significantly from the bipolar measurements (atrial: p = 0.058, ventricular: p = 0.138). There was no exit block or undersensing. Conclusion: The results demonstrate that unipolar stimulation and sensing using bipolar epicardial temporary pacing wires is feasible. In the case of failure of bipolar temporary pacing wires, this modality represents an easy rescue measure that in such cases should always be considered.

Keywords

Congenital heart defectcongenital cardiac repairepicardial pacingpost-operative temporary unipolar pacingbipolar pacingtemporary pacing wirestemporary pacing electrodes
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 4 , August 2014 , pp. 610 - 615
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Batra, AS, Balaji, S. Post operative temporary epicardial pacing: when, how and why? Ann Pediatr Cardiol 2008; 1: 120–125.Google Scholar
2. Wirtz, S, Schulte, HD, Winter, J, Godehardt, E, Kunert, J. Reliability of different temporary myocardial pacing leads. Thorac Cardiovasc Surg 1989; 37: 163–168.Google Scholar
3. Yiu, P, Tansley, P, Pepper, JRA. Improved reliability of post-operative ventricular pacing by use of bipolar temporary pacing leads. Cardiovasc Surg 2001; 9: 391–395.Google Scholar
4. Elmi, F, Tullo, NG, Khalighi, K. Natural history and predictors of temporary epicardial pacemaker wire function in patients after open heart surgery. Cardiology 2002; 98: 175–180.Google Scholar
5. Rusanov, A, Spotnitz, HM. Salvage of a failing bifurcated bipolar epicardial lead with conductor fracture. Ann Thorac Surg 2010; 90: 649–651.Google Scholar
6. Paul, T, Luhmer, I, Wilken, M, Kallfelz, HC. Emergency 12-hour transesophageal stimulation in a 21-month-old infant. Anaesthesist 1993; 42: 564–566.Google Scholar
7. Hessling, G, Brockmeier, K, Ulmer, HE. Transesophageal electrocardiography and atrial pacing in children. J Electrocardiol 2002; 35 (Suppl): 143–149.Google Scholar
8. Kohler, H, Zink, S, Scharf, J, Koch, A. Severe esophageal burn after transesophageal pacing. Endoscopy 2007; 39 (Suppl 1): E300.Google Scholar
9. Knilians, TK. Arrhythmia. In: Wheeler DS, Wong HR, Shanley, TP (eds.). Pediatric Critical Care Medicine: Basic Science and Clinical Evidence, Springer, London, 2007: 785–796.Google Scholar
10. Lee, KL, Lau, CP, Tse, HF, et al. First human demonstration of cardiac stimulation with transcutaneous ultrasound energy delivery: implications for wireless pacing with implantable devices. J Am Coll Cardiol 2007; 50: 877–883.Google Scholar
11. Valsangiacomo, E, Schmid, ER, Schupbach, RW, et al. Early postoperative arrhythmias after cardiac operation in children. Ann Thorac Surg 2002; 74: 792–796.CrossRefGoogle ScholarPubMed
12. Rekawek, J, Kansy, A, Miszczak-Knecht, M, et al. Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period. J Thorac Cardiovasc Surg 2007; 133: 900–904.Google Scholar
13. Bar-Cohen, Y, Silka, MJ. Management of postoperative arrhythmias in pediatric patients. Curr Treat Options Cardiovasc Med 2012; 14: 443–454.Google Scholar
14. Ceresnak, SR, Pass, RH, Starc, TJ, et al. Predictors for hemodynamic improvement with temporary pacing after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2011; 141: 183–187.Google Scholar