Publications

BACKGROUND

Temporary epicardial pacing wires are used routinely after coronary artery bypass graft (CABG) surgery and can cause rare, catastrophic complications. This study's purpose was to identify patient characteristics predicting the need for pacing after CABG surgery with the potential to limit their utilization.

METHODS

This prospective observational study involved 290 consecutive patients undergoing CABG at our institution from August 2000 to January 2001. Sixty-eight patients were excluded for the following reasons: off-pump CABG, preoperative pacemaker, no pacing wire placement, or incomplete follow-up. Among the remaining 222 patients, the incidence of pacing during the postoperative period was recorded. Univariate and independent multivariate predictors for postoperative pacing were determined using medical records, the Johns Hopkins Hospital cardiac surgery database and the Society of Thoracic Surgery database.

RESULTS

In the postoperative period, 19 of 222 patients (8.6%) required pacing. Univariate analysis identified age, cardiomegaly, preoperative antiarrhythmic therapy, diabetes mellitus, preoperative arrhythmia, inotropic agents leaving the operating room, and pacing initialized at the separation from cardiopulmonary bypass as predictors of the need for postoperative pacing. Only diabetes mellitus, preoperative arrhythmia, and pacing utilized to separate from bypass were found to be significant on multivariate analysis. Using this model, if we exclude the patients with any of these three risk factors, only 2.6% of them would have required pacing.

CONCLUSIONS

Few patients require temporary epicardial pacing after routine CABG. This study identified specific predictors for postoperative pacing requirements and provides criteria for the selective use of epicardial pacing wires after CABG.

Hyperpolarized (3)He MRI of the human lung was performed at 0.54 and 1.5 T using identical software and hardware (except for RF coils) at both field strengths. The T(*) (2) of (3)He gas in the lung was measured, and the effects of magnetic-susceptibility-induced field inhomogeneities on the appearance of interleaved-spiral and interleaved-echo-planar lung images at 1.5 T were compared to those at 0.54 T. Mean T(*) (2) values for (3)He gas in the healthy human lung were 26.8 +/- 1.5 ms and 67.9 +/- 1.3 ms at 1.5 and 0.54 T, respectively. At 0.54 T, interleaved-spiral images showed markedly less blurring due to susceptibility effects compared to images acquired at 1.5 T. At both 0.54 and 1.5 T, interleaved-echo-planar images appeared essentially identical to corresponding GRE images, even though the data-sampling period per echo and echo time were substantially longer for the interleaved-echo-planar images acquired at 0.54 T.

Gliotoxin was measured in the lungs (mean, 3,976 +/- 1,662 ng/g of tissue) and sera (mean, 36.5 +/- 30.28 ng/ml) of mice with experimentally induced invasive aspergillosis (IA), and levels decreased with antifungal therapy. Gliotoxin could also be detected in the sera of cancer patients with documented (proven or probable) IA.