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What is temporary pacing?
Following open heart surgery, patients often experience rhythm disturbances which can lead to serious complications during recovery. To counter this, cardiac surgical patients are typically fitted with a temporary pacing system in order to regulate the heart’s rhythm and ensure a near-normal cardiac output is maintained.
Post-surgical temporary pacing therapy is achieved by attaching a pacing wire to the outer surface of the heart, feeding the wire through the patient’s abdomen, and attaching this to an extension lead which is inserted into a temporary pacing device that is kept at the bedside.
Research and experience show epicardial pacing wires to be both unstable and subject to degeneration from epithelialisation (scar tissue formation), with published articles highlighting the potential dangers of temporary pacing and recommending that checks on the pacing parameters of such devices be performed at least every 12 hours.
This instability, coupled with devices that lack the sophistication seen in modern permanent pacing, as well as device management typically undertaken by ITU doctors and nurses operating in high pressured environments, can lead to a failure to identify acute and sudden changes in device function or patient underlying rhythm. As a result, cardiac output may be affected, resulting in higher use of inotrope (muscle contraction) medication and an extended and costly ITU stay. Other more serious consequences of a failure to recognise acute changes in pacing function can lead to serious harm to the patient, including causing cardiac arrest and death.
There are around
Serious Adverse Events reported with temporary pacemakers each year in the U.S. alone, including as the identified cause of death.
Case reports and studies have been published highlighting problems that exist with the management of temporary cardiac pacing
Temporary pacing safety is clearly an unaddressed problem in post cardiac surgical care. Audits published recently by Harefield hospital (2018) and St. Bart’s Hospital (2019) both highlighted serious problems in the management of temporary pacing in the post-surgical ITU setting. These investigations reported high incidences of failure to recognise loss of capture, oversensing, undersensing (consequences of lead contact degeneration), poor pacing mode selection and other errors in programming, all of which can be extremely hazardous to the patient.
An online survey was undertaken through LinkedIn that asked if medical professionals working with temporary pacing believed there to be a issues with patient safety. 108 responses were obtained with 75% either agreeing or strongly agreeing that issues with patient safety in the management of temporary pacing exist.
To counter this problem, Cardiac Tech Ltd. is developing a safety device which is designed to monitor all aspects of temporary pacing function and report acute changes immediately to the medic or nurse managing the patient.
The device monitors signals and alerts wherever dangerous changes in pacing function have occurred, bringing help to the patient before an adverse event can occur.
If you are interested to learn more about the technology, contact Cardiac Tech.
- Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review: part 1 – https://pubmed.ncbi.nlm.nih.gov/17381573/
- Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review. Part 2 – https://pubmed.ncbi.nlm.nih.gov/17381573/
- Cristina Lazarescu, Samia Kara-Mostefa, Jean-Marie Parlanti, Michel Clavey, Paul-Michel Mertes, Dan Longrois. Reassessment of the Natural Evolution and Complications of Temporary Epicardial Wires After Cardiac Surgery – https://pubmed.ncbi.nlm.nih.gov/24534148/
- Nakamori Y, Maeda T, Ohnishi Y. Reiterative ventricular fibrillation caused by R-on-T during temporary epicardial pacing – https://pubmed.ncbi.nlm.nih.gov/29497660/
- Lopez C, Oloriz T, Calvo N, Sancho I, Diaz F, Asso A. Polymorphic ventricular arrhythmia triggered by temporary epicardial right ventricular stimulation after cardiac surgery – https://pubmed.ncbi.nlm.nih.gov/29296578/
- Chemello D, Subramanian A, Kumaraswamy N. Cardiac arrest caused by undersensing of a temporary epicardial pacemaker – https://pubmed.ncbi.nlm.nih.gov/20101359/
- Peter M. Schulman, Matthias J. Merkel, Marc A. Rozner. Accidental, Unintentional Reprogramming of a Temporary External Pacemaker Leading to R-on-T and Cardiac Arrest – https://www.jcvaonline.com/article/S1053-0770(12)00356-4/fulltext
- Shepard, Suzanne M. RN, BSN; Tejman-Yarden, Shai MD, MSc; Khanna, Sandeep MD; Davis, Christopher K. MD, PhD; Batra, Anjan S. MD Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery – https://pubmed.ncbi.nlm.nih.gov/20959781/