Is it worth placing ventricular pacing wires in all patients post-coronary artery bypass grafting?

Abstract A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether ventricu-lar pacing wires should be placed routinely in all patients undergoing coronary artery bypass grafting (CABG) regardless of immediatepost-cardiopulmonary bypass (CPB) rhythm status. Using the reported search, 142 papers were found, from which 10 papers repre-sented the best evidence on the subject. The author, date and country of 10 publications, study type, patient group studied, relevantoutcomes and results are tabulated. Complete atrio-ventricular (AV) block is the main reason for inserting ventricular pacing wires uponconclusion of CABG. Eight studies found complete AV block to be a rare entity post-CABG. The rate of complete AV block in CABG inour review ranged from 0.3 to 24%. The calculated average rate of AV block in all studies was 2.4%. The number needed to treat withventricular wires to support a patient who develops AV block is 42. One randomized controlled trial found 3% risk of complete AVblock post-CABG. Another cohort of 222 patients revealed a rate of 1.8% for complete AV block. For one cohort of 770 patients, post-CABG the rate of complete AV block was found to be 0.3%. In one cohort of 25 patients, there was a rate of 4% for complete AV blockpost-CABG. Another study of 564 patients revealed a rate of 0.7% for complete AV block. A study of 4999 patients post-CABG reporteda rate of 1.2% for complete AV block. In one cohort of 93 patients, there was a 4% risk of complete AV block. Another cohort of 62patients showed a rate of 1.6% for complete AV block. Only two papers found the rate of complete AV block post-CABG to be as highas 24 and 16%. Both studies were limited by sample size. In conclusion, routine ventricular pacing wire insertion post-CABG is unneces-sary given that routine use of ventricular wires can occasionally cause complications such as bleeding and cardiac tamponade and thusis not risk free. We also found that the incidence of complete AV block is probably higher in on-CPB CABG than off-CPB CABG andthat AV pacing may be haemodynamically beneficial for some patients postoperatively.Keywords: Cardiac pacing † Epicardium † Coronary artery bypass grafting † Atrio-ventricular block