[HSF] Postop cardiac syncope

[Ani Anyanwu]

Hal

I suspect Bojan might be referring to a reusable endocardial lead as Prasanna alluded to.

Surely, however, the solution is to learn how to do a procedure properly and safely rather than to run away from it hoping all will be well or seek "cheaper" alternatives? I remember a surgeon I trained under who would never do mediastinoscopies (preferring instead a unilateral (or even bilateral)) chamberlain mediastinotomy and when I enquired why he said that mediastinoscopy was a dangerous procedure and should only be done when there was absolutely no alternative. I was later told that twelve years previously in his first month of practice he had lost two patients from bleeding during mediastinoscopy. The solution has to be to device ways (several of which have been reported in this thread) to place and remove wires safely rather than avoid them or design cheaper less reliable alternatives? 

I personally think that most tamponades after pacing wire removal are related to improper placement. I had one of mine bleed 4 years ago while in training and rather than shy from using them I learnt how to place them properly (as my boss said that clearly - and I agreed _ there must have been a problem with the way I had placed them) and started paying great attention to this seemingly 'mundane' task. I certainly now would not decide against placing a wire because of concern about bleeding (but very occasionally may chose not to place one because I feel it is unnecessary) and like others we not infrequently place several wires on both ventricles and either atrium. I also pull the wires out regardless of the coagulation status, even when INR has been greater than 3, as, if the wires have been well placed, the coagulation status should have no bearing on the likelihood of bleeding.

Ani
  ----- Original Message ----- 
  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Saturday, April 14, 2007 6:26 PM
  Subject: Re: [HSF] Postop cardiac syncope


  Bojan,
    You are recommending a permanent endocardial lead for temporary  pacing?  
  Not even I am that wasteful of hospital resources.
  Hal



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