Iatrogenic Epicardial Pacing-Induced Arrhythmias After Cardiac Surgery.

OBJECTIVES: To investigate 3 cases of iatrogenic polymorphic ventricular tachycardia related to inappropriately programmed temporary epicardial pacing devices and to provide an educational overview of temporary epicardial pacing devices to trainees and health care professionals caring for patients undergoing cardiac surgery. DESIGN: A case series reviewing 3 cases of iatrogenic ventricular arrhythmias resulting from inappropriately programmed temporary epicardial pacing devices. SETTING: A university hospital. PARTICIPANTS: Three patients who received cardiac surgery and had temporary epicardial pacing wires placed intraoperatively. INTERVENTIONS: Situation-specific changes were made to temporary epicardial wire programming. MEASUREMENTS AND MAIN RESULTS: Each of the 3 patients experienced polymorphic ventricular tachycardia as a result of epicardial pacing wire undersensing. Identification of inappropriate epicardial pacer settings as the cause of these arrhythmias resulted in course correction of each patient's management, including modification of epicardial pacer settings and avoidance of unnecessary procedural interventions. CONCLUSIONS: Epicardial lead-associated iatrogenic arrhythmias represent a safety hazard to patients after cardiac surgery. There is confusion surrounding the counterintuitive terminology describing epicardial device settings. It is likely that many cases such as those presented here involve unidentified opportunities. Understanding the programmable parameters of temporary epicardial pacing may improve patient outcomes.