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Background: Atrial arrhythmias are common after pediatric cardiac surgery and are associated with increased morbidity and mortality. Atrial epicardial wires (AEW), utilized to diagnose and treat atrial arrhythmias, are known to malfunction during post-operative care. There are no pediatric prospective studies examining ideal placement of AEW. Methods: This prospective multicenter pilot study compared atrial amplitudes, pacing sensitivities and thresholds via AEW placed at Bachmann’s Bundle (BB) and the right-sided interatrial groove (RSIG) versus the surgeon’s standard placement (control locations) in 26 patients aged less than six years old undergoing cardiac surgery. Participants received four total AEW - two at the experimental locations (BB-RSIG) and two at control locations. An AtriAmp system was used to obtain an atrial ECG to calculate atrial and ventricular amplitudes. We documented pacing sensitivities and thresholds by connecting AEW to a temporary pacing box. We calculated descriptive statistics and used ANOVA test to detect differences across groups. Results: N=26 patients were represented. There were no demographic differences between hospitals. The combined mean patient characteristics at time of surgery included: age 3.2 yr (SD 3.6), weight 14.6 kg (SD 12.4), cardiopulmonary bypass time 111.8 min (SD 51.1). Within hospitals and combined, comparison of AEW characteristics showed greater atrial amplitude at BB-RSIG versus control locations (Table). Phrenic nerve capture was common during test pacing (n=13/26). Conclusion: This is the first prospective multicenter pediatric study to suggest that standard atrial wire site selection may improve atrial signals obtained from the atrial epicardial wires.


Cardiology | Pediatrics


Presented at the 8th World Congress of Pediatric Cardiology and Cardiac Surgery; Washington, DC; August 27th-Sept 1, 2023.

Standard Atrial Epicardial Wire Placement Leads to Improved Atrial Signal Identification and Pacemaker Sensing