Tempor?re Schrittmachertherapie bei herzchirurgischen Operationen

Bradycardia during and after cardiac surgery requiring temporary pacing is observed in roughly 50% of patients. Complete heart block as well as bradycardia associated with a sinus node dysfunction or permanent atrial fibrillation are the most common types of perioperative bradycardia; however, in some cases even a heart rate below 80 beats/min can be associated with hemodynamic problems. Finally, the occurrence of bradycardia in the immediate postoperative period after cardiac surgery cannot be predicted with reasonable accuracy. Thus, implantation of temporary epimyocardial stimulation leads in every patient undergoing cardiac surgery is common practice. The versatility of temporary pacing in cardiac surgery is unique, as all parts of the heart can be accessed during the operation. Thereby it allows temporary atrial, AV-sequential, P-wave synchronized or biventricular pacing in addition to ventricular pacing, the only pacing mode available for temporary pacing outside cardiac surgery. This results in desirable and substantial hemodynamic advantages compared to single chamber ventricular pacing for cardiac surgery patients in the perioperative period. This article summarizes the key elements of temporary pacing after cardiac surgery and adds some practical points.