Safety of Temporary

Pacemaker Wires
Clinical Indications of Temporary
Pacemaker
• Maintain heart rhythm and/or rate postoperatively, esp in reduced LV
function patients
• Manage postoperative atrial or ventricular arrhythmia
• The prevention of postoperative atrial fibrillation (40%)
Technical issues and strategies of
temporary pacemakers

• Bipolar configuration of epicardial pacing wires are preferred

• The other configuration is only one ventricular wire inserted
• Ensure that the wires are in good contact with the myocardium, and the 2 wires are 1–2 cm apart
• Putting a loop  allow mobilization
• Careful positioning of the wire
Technical issues and strategies of
temporary pacemakers
• Atrial wires are inserted in a thick atrial wall near the atrial appendage
or interatrial groove
• Biventricular pacing: RV wires and 2 left ventricular epicardial wires
Technical issues and strategies of
temporary pacemakers

• Not to suture the wires except to control bleeding

• Cutting and retaining the wires, will be the safest option to avoid
injury or laceration at the time of wire removal

• Keep enough of a loop within the pericardial cavity to allow free

cardiac activity without putting stress on the wires
Technical issues and strategies of
temporary pacemakers

• Allow mobilization of the heart without the risk of accidental removal

of the wires

• Ensure carful positioning of the wires in relation to chest tubes and

coronary grafts to prevent accidental removal of the wires during
chest tube removal, or accidental graft injury or clip dislocation at the
time of wire removal
Technical issues and strategies of
temporary pacemakers

• Secured with a 2/0 silk suture or with a loop of the wire itself

• Thresholds for pacing and sensing should be performed in the

operating room prior to chest closure, especially in pacing-dependent
patients.
Complications of Temporary
Pacemaker Wires

Wire insertion During usage During removal

Complication during Insertion
• Prolong operative time
• Bleeding from the ventricular or atrial surface
• Puncture of nearby organs
• Hematoma at the exit of the wires
Complication of Prolonged Use
• Significant elevation of the capture threshold and a decrease in
sensitivity (POD 2-4)
• Failure of sensing or capturing
• Pacing-induced ventricular fibrillation
Complication during removal
• Arrhythmias  irritation of RV
• Bleeding  laceration
• Tamponade
Complication of Retained wires
• Irritation and erosion through the skin
• Unpleasant cutaneous tingling pain
• Pain referred to the shoulders
• Persistent chest wall sinus
• Irritation and disfigurement
Complication of Retained wires
• Migrate to different structures in the chest
• Perforation of cardiac structures
• Localized infection
• Localized abscess

retained pacing wire

surrounded by fluid that proved to be due to
infection
Temporary Epicardial wires and MRI
• MRI is not advisable while epicardial leads remain in place
Because:
• precipitate an arrhythmia
• heating at the electrode tip
• patients with retained epicardial wires that have been cut off at the
skin (and hence have no long antennae) can get MRI safely
Safety Measure to Reduce
Pacemaker Wire Complications
• Inserting temporary pacing wires only in a selected subgroup of
patients (diabetic, preop arrythmia)
• Proper placement of pacing wires
• Use of a pacemaker button
Safety Measure to Reduce
Pacemaker Wire Complications
• The coagulation status of the patient should be assessed before
removal of temporary pacing wires

• Highly recommended to pull and extract the temporary pacing wires

completely

• If the wires are retained, proper documentation has to be carried out

to indicate the site and type of retained wires
Safety Measure to Reduce
Pacemaker Wire Complications

• After temporary pacemaker wire removal, vital signs are measured

every 15 min for the first hour, then every 30 min for the next hour,
and once every hour for the next 2 hours

• Keep the patient under observation for 4 hours after pacing wire
removal
Conclusion
• Temporary pacemaker wires are useful in the management of
selected patients undergoing cardiac surgery
• Temporary pacing wires carry a small but significant safety risk
• Complications may occur during wire insertion, during pacing
postoperatively, at the time of wire removal, or if the wires are
retained inside the body
• Careful insertion and removal are warranted
Thank You