Cardiac Tamponade After Removal of Temporary Pacer Wires

Abstract

Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

“…Mahon et al mention a less than 1% need for re-exploration due to pericardial tamponade after removal of EPW in a retrospective study involving more than 23000 patients with cardiac surgery [3]. These data coincide with our findings, showing eight patients with pericardial tamponade, where removal of EPW was the definite cause of bleeding (incidence 0.18%).…”

“…These temporary wires are removed postoperatively after a stable cardiac rhythm has been established. A rare but potentially hazardous complication of removal of these wires is the development of a cardiac tamponade necessitating the re-exploration of the patient [1–3]. The exact incidence of this complication remains uncertain, whereas its prevention in the era of dual antiplatelet therapy (DAPT) and modern anticoagulant medicaments, such as novel oral anticoagulants (NOACs), seems to be challenging.…”

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

“…In these cases, the removal of the temporary pacing wire probably exposed the right ventricular perforation site, which led to the cardiac tamponade. Such cases, although rarely reported in the literature, might not be uncommon, and highlight the importance of careful management of patients with temporary pacing wires, including avoidance of frequent lead repositioning, usage of balloon-tipped pacing wires, monitoring arterial blood pressure for hemodynamic collapse, and accounting for the elimination half time of the GP IIb/IIIa inhibitor antiplatelet agent before removal of the temporary pacing wire [21,22].…”

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

“…The incidence and early symptoms of this complication following removal of temporary pacer wires were retrospectively studied in a single center. 4 During the 10-year study period, 23 717 patients were reviewed. Cardiac tamponade after removal of temporary pacer wires was rare (~0.1%).…”