Determining the Predictors of Temporary Epicardial Pacing Wires Use After Isolated Coronary Artery Bypass Grafting Surgery.

Background: Coronary artery bypass grafting (CABG) is frequently associated with postoperative arrhythmias, often necessitating temporary cardiac pacing (TCP). The routine placement of temporary epicardial pacing wires (PWs) remains controversial due to potential complications. This study aimed to identify predictors for TCP after isolated CABG to guide selective PW use and improve perioperative outcomes.

Methods: A retrospective analysis was conducted on 1,395 patients who underwent isolated CABG with cardiopulmonary bypass (CPB) at King Abdullah University Hospital, Jordan, between 2004 and 2022. Patients undergoing redo surgeries or presenting with high-grade atrioventricular block, ischemic ventricular septal defect, or missing data were excluded. Patients were grouped based on PW placement, and predictors for TCP were assessed using univariate and multivariate logistic regression.

Results: Among the 1,395 patients, 887 received PWs, and 127 required TCP. Significant predictors for TCP included preoperative bundle branch block (BBB), intraoperative blood transfusion, prolonged vasoactive support, and mechanical ventilation exceeding 12 hours postoperatively. Preoperative beta-blocker use was associated with reduced risk of TCP. Demographics, comorbidities, and prolonged CPB or aortic cross-clamp times were not significant.

Conclusion: Preoperative BBB and postoperative complications were associated with increased TCP risk, while beta-blocker use was protective. These findings support a risk-based strategy for PW placement after CABG to reduce complications and improve resource allocation. Prospective studies are needed to validate these predictors and refine perioperative protocols.