Atrial Electrograms After Cardiac Surgery: Survey of Clinical Practice

2007 ◽  
Vol 16 (4) ◽  
pp. 350-356 ◽  
Author(s):  
Jane N. Miller ◽  
Barbara J. Drew
Keyword(s):  
Cardiac Surgery ◽  
Unknown Origin ◽  
Heart Association ◽  
Convenience Sample ◽  
Nursing Experience ◽  
Electrocardiographic Monitoring ◽  
Cardiac Monitor ◽  
Atrial Electrograms ◽  
Atrial Electrogram ◽  
Epicardial Pacing

Background The American Heart Association 2004 practice standards for electrocardiographic monitoring in hospitals recommend that nurses record an atrial electrogram whenever tachycardia of unknown origin develops in a patient after cardiac surgery. An atrial electrogram can be recorded from atrial epicardial pacemaker wires left in place following surgery. Because surgical practices have changed in recent years (earlier extubation and mobilization, shorter stays), it is unclear whether epicardial wires are still readily available to record an atrial electrogram. Objective To determine current practices in recording atrial electrograms. Methods A convenience sample of nurses subscribing to the American Association of Critical-Care Nurses electronic newsletter was surveyed. Results The sample comprised 247 nurses who worked in an intensive or progressive care unit in which patients were treated after cardiac surgery. Respondents were from 41 states and 139 cities. Nearly 90% of respondents had more than 5 years’ nursing experience; 75% had more than 5 years’ experience caring for patients after cardiac surgery. Although 92.1% of respondents reported that atrial epicardial pacing wires were left in place after cardiac surgery, only 10.2% recorded atrial electrograms often, and more than 30% had never recorded one. Analysis of written comments indicated that atrial electrograms are rarely used. Among nurses who had recorded an atrial electrogram, recordings were made about equally with a standard 12-lead electrocardiography machine and a bedside cardiac monitor. Conclusions Although atrial epicardial pacemaker wires are often available for recording atrial electrograms, few nurses use apical epicardial wires for atrial electrograms to analyze arrhythmias.

Risks associated with removal of ventricular epicardial pacing wires after cardiac surgery

1998 ◽  
Vol 7 (6) ◽  
pp. 444-449 ◽  
Author(s):  
KC Carroll ◽  
LM Reeves ◽  
G Andersen ◽  
FM Ray ◽  
PL Clopton ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Premature Ventricular Contraction ◽  
Premature Ventricular Contractions ◽  
Convenience Sample ◽  
Nonsustained Ventricular Tachycardia ◽  
Electrocardiographic Monitoring ◽  
History Of ◽  
Epicardial Pacing

BACKGROUND: Epicardial pacing wires are routinely used for the diagnosis and treatment of bradyarrhythmias after cardiac surgery. The frequency of arrhythmias during removal of the wires is unknown, and methods of removal vary among institutions. OBJECTIVES: To describe the frequency of ventricular arrhythmias during removal of epicardial pacing wires from the right ventricle, to determine variables that are predictive of ventricular arrhythmias during wire removal, and to describe patients' perceptions of wire removal. METHODS: A convenience sample of 145 patients who had undergone cardiac surgery was studied during the course of 1 year. Electrocardiographic and vital signs were recorded throughout wire removal. Patients' records were reviewed for variables that could predict the occurrence of arrhythmias during wire removal: laboratory values, history of arrhythmias, medications, medical history, postoperative course, and pain reported by the patient. RESULTS: Sixty-six percent of patients had one premature ventricular contraction or more while the ventricular wires were being removed. Seven percent of patients had nonsustained ventricular tachycardia during wire removal. Patients who had repeat cardiac surgery had significantly more nonsustained ventricular tachycardia than did all other patients (P < .01). Only a history of heart failure (P < .02) was a significant predictor of premature ventricular contractions during wire removal. On a scale of 0 (no pain) to 10 (worst pain), the mean rating of pain intensity reported by patients was 2.39 (SD = 2.77). CONCLUSION: Patients may be at risk for ventricular arrhythmias during removal of epicardial pacing wires. Findings support the need for electrocardiographic monitoring while pacing wires are being removed.

The Use of Atrial Electrograms in the Diagnosis of Supraventricular Dysrhythmias

1992 ◽  
Vol 3 (1) ◽  
pp. 203-208
Author(s):  
Laurel Dziadulewicz ◽  
Rita Lang
Keyword(s):  
Cardiac Surgery ◽  
Atrial Electrograms ◽  
Epicardial Pacing ◽  
Nursing Diagnoses

Temporary epicardial pacing wires are frequently used to perform atrial electrograms in patients after cardiac surgery. This article reviews Einthoven’s triangle and describes a method of obtaining and evaluating atrial electrograms. Examples of specific dysrhythmias and nursing diagnoses relating to atrial wires are also described

Epicardial Pacing to Control Arrhythmias Following Cardiac Surgery

Circulation ◽  
1968 ◽  
Vol 37 (4s2) ◽  
Author(s):  
PAUL D. HARRIS ◽  
JAMES R. MALM ◽  
FREDERICK O. BOWMAN ◽  
BRIAN F. HOFFMAN ◽  
GERARD A. KAISER ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Epicardial Pacing

scholarly journals Sample Entropy Analysis of Noisy Atrial Electrograms during Atrial Fibrillation

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Eva María Cirugeda-Roldán ◽  
Antonio Molina Picó ◽  
Daniel Novák ◽  
David Cuesta-Frau ◽  
Vaclav Kremen
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Heart Tissue ◽  
Sample Entropy ◽  
Mapping Technique ◽  
Atrial Electrograms ◽  
Invasive Method ◽  
Atrial Electrogram ◽  
Focal Atrial Tachycardia ◽  
Class Segmentation

Most cardiac arrhythmias can be classified as atrial flutter, focal atrial tachycardia, or atrial fibrillation. They have been usually treated using drugs, but catheter ablation has proven more effective. This is an invasive method devised to destroy the heart tissue that disturbs correct heart rhythm. In order to accurately localise the focus of this disturbance, the acquisition and processing of atrial electrograms form the usual mapping technique. They can be single potentials, double potentials, or complex fractionated atrial electrogram (CFAE) potentials, and last ones are the most effective targets for ablation. The electrophysiological substrate is then localised by a suitable signal processing method. Sample Entropy is a statistic scarcely applied to electrograms but can arguably become a powerful tool to analyse these time series, supported by its results in other similar biomedical applications. However, the lack of an analysis of its dependence on the perturbations usually found in electrogram data, such as missing samples or spikes, is even more marked. This paper applied SampEn to the segmentation between non-CFAE and CFAE records and assessed its class segmentation power loss at different levels of these perturbations. The results confirmed that SampEn was able to significantly distinguish between non-CFAE and CFAE records, even under very unfavourable conditions, such as 50% of missing data or 10% of spikes.

scholarly journals The unusual journey of a retained epicardial pacing wire

2017 ◽  
Vol 11 ◽  
Author(s):  
Francesca Giacomazzi ◽  
Lorenzo Menicanti ◽  
Massimo Lombardi ◽  
Roberto Tramarin
Keyword(s):  
Cardiac Surgery ◽  
Unusual Case ◽  
Routine Procedure ◽  
Epicardial Pacing

The placement of temporary epicardial pacing wires (EPWs) at the completion of cardiac surgery is a routine procedure in most centres. Complications related to their insertion, removal and retention are infrequent, yet potentially severe, including hemorrhage, tamponade, infection and death. Here, we describe an unusual case of retained temporary EPW migration.

ECG Monitoring After Cardiac Surgery

2007 ◽  
Vol 18 (3) ◽  
pp. 294-304
Author(s):  
Leslie S. Kern ◽  
Marion E. McRae ◽  
Marjorie Funk
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Preventive Therapy ◽  
Cost Of Care ◽  
Adverse Outcomes ◽  
Postoperative Atrial Fibrillation ◽  
History Of ◽  
Bedside Monitor ◽  
Atrial Electrogram ◽  
Ventricular Activity

Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. β-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. In the postoperative period, the nurse plays an important role in the early detection of atrial fibrillation by the recording of an atrial electrogram, which is easily obtained from the bedside monitor. Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.

Abstract P215: Decreased Pre-Operative Risks and Increased Post-Operative Mental Functioning as Benefits of Regular Physical Activity for Patients Undergoing Cardiac Surgery

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Lori E Stone ◽  
Sari D Holmes ◽  
Lisa M Martin ◽  
Sharon L Hunt ◽  
Niv Ad
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiac Surgery ◽  
Cost Benefit ◽  
Heart Association ◽  
Exercise Group ◽  
Regular Physical Activity ◽  
Operative Risk ◽  
Regular Exercise ◽  
Composite Scores

Background: Regular exercise is a known primary and secondary defense against cardiovascular disease. Additionally, the American Heart Association has shown that regular exercisers have a decreased physiological response to stress, exhibit less anxiety and depression, and have better self-esteem. Objective: To examine the pre-operative risk factors and post-operative course of recovery for regular exercisers in cardiac surgery patients. Methods: A review was done of patient generated history forms and medical data for 281 patients that underwent isolated CABG at our institution since 2007. Only 166 patients had complete history forms: 98 patients were determined to be regular exercisers prior to CABG surgery, compared to 68 non-exercisers. A subset of patients (64 exercisers and 44 non-exercisers) also completed the SF-12 to measure health related quality of life (HRQL) at baseline and 12 months post-operatively. Results: Analyses found that the regular exercisers presented with better pre-operative risk factors than the sedentary patients, including lower BMI (t=2.6, p<0.02), lower STS morbidity/mortality risk score (t=3.3, p<0.003), lower logEuroScore (t=1.9, p=0.058), and fewer patients with diabetes (OR=0.47, p<0.04). The regular exercise group was also less likely to report depression (6% vs. 16%; Chi-square = 4.2, p<0.04) and presented with a higher physical composite HRQL at baseline than the non-exercisers (t=-3.6, p<0.001). Post-operative HRQL scores indicated that while both groups increased significantly from baseline to 12 months on physical composite scores, only the regular exercisers significantly improved on the mental composite scores (t=2.2, p<0.04). Conclusion: The importance and overall cost-benefit of regular physical activity can not be overemphasized. Regular exercisers have been shown to be at reduced risk for an adverse cardiac event. For those that must undergo cardiac surgery, the physically active present with reduced pre-operative risk and superior physical HRQL. Regular exercisers also experience greater post-operative improvements in mental HRQL as compared to their sedentary peers.

Atrial Electrograms After Cardiac Surgery

2007 ◽  
Vol 16 (4) ◽  
pp. 360-360
Author(s):  
Linda Bell ◽  
Todd Sargood
Keyword(s):  
Cardiac Surgery ◽  
Atrial Electrograms

Epicardial pacing wires after cardiac surgery: an Irish cross-sectional study

2020 ◽  
Vol 29 (8) ◽  
pp. 476-480
Author(s):  
Niamh Kiely ◽  
Frances O'Brien ◽  
Mary Mooney
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Best Practice ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Delayed Discharge ◽  
Epicardial Pacing ◽  
Delayed Removal

Background: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. Methods: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. Results: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. Conclusion: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.

scholarly journals Vision loss after spine surgery: review of the literature and recommendations

2007 ◽  
Vol 23 (5) ◽  
pp. E15 ◽  
Author(s):  
Mirza N. Baig ◽  
Martin Lubow ◽  
Phillip Immesoete ◽  
Sergio D. Bergese ◽  
Elsayed-Awad Hamdy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Literature Review ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Vision Loss ◽  
Spinal Instrumentation ◽  
Unknown Origin ◽  
Current Understanding ◽  
Review Of The Literature ◽  
Practical Guidelines

✓In recent studies spinal surgery has replaced cardiac surgery as a leading cause of postoperative vision loss (POVL). Estimates of the incidence of POVL after spinal surgery range from 0.028 to 0.2%, but with advances in complex spinal instrumentation and the rise in annual spinal operations, POVL may see an ominous increase in its incidence. Postoperative vision loss is an uncommon but devastating complication, with unknown origin and pathogenesis. The authors undertook a literature review and summarize the current understanding of its pathophysiology, highlight the limitations of existing knowledge, and recommend practical guidelines for avoiding this devastating outcome.

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