Epicardial Pacing Wires

Advanced Practice Columnist / Guide · Sep 17, 2012

There are two wires for Atrial Pacing and two wires for Ventricular Pacing. If the surgeon only wants A-pacing, there will be two wires on the right side of the chest below the midsternal incision; AV-pacing will have 4 wires, 2 on the right and 2 on the left; V pacing will have two wires on the left. Wires are sometimes color-coded depending on surgeon preference (A wires are sometimes orange - the color coding is not only beneficial for identification but also has a shorter wire that is implanted on the epicardium since the atrial wall is thinner). All wires are sutured into the epicardium during surgery, they have a needle in the end of them when the package is opened and the surgeon sutures the wire in place on the epicardium and out through the chest wall eventually exiting out to the skin then snips the needle off once the wires are in place. They are looped outside of the skin, sutured in place with stitches for extra protection from being accidentally pulled.

Lgbird · Sep 17, 2012

Thank you!!!

So, for AV pacing. There are a total of 4 leads? Two A wires, and two v wires or is there one A wire, one v wire and two skin leads?

Advanced Practice Columnist / Guide · Sep 17, 2012

All the leads are in contact with the epicardium...there are no skin leads.

Advanced Practice Columnist / Guide · Sep 17, 2012

The two sets have to do with polarity as electrical currents travel through. Electricity travels in a circuit from the positive pole to the negative pole. It is also possible to have a single wire - a negative lead or cathode (some permanent pacemakers are single wired). There would be no purpose for a skin lead. Sometimes switching the positive and negative wires could help with pacing when it isn't capturing, in those instances what might have happened is that the negative lead has come off contact with the epicardium and switching the polarity enhanced the transmission of electrical impulse to the epicardium.

Editorial Team / Admin · Sep 17, 2012

The surgeons I work with will put in 4 wires- 2 atrial, 2 ventricular. The atrial are white and on the right, the ventricular are orange and on the left. They don't always AV pace, but at least by putting all 4 in, they have that option if it becomes necessary. Had one patient who was beating away on his own, then we needed to A pace him, and then he became completely pacer dependent. Our V wires aren't sutured in place, there's branches that hook into the heart itself. The A wires are sutured in place but with a very fine suture that still allows them to be pulled out without damaging the heart. Sometimes we need more sutures to hold the A wires in place, and then the docs write an order to cut the wires instead of pull them.

missnurse01, MSN, RN · Sep 19, 2012

I think skin wires you are talking about might be ground wires. We have the usual a and v bipolar wires, although we can have a variety of things when we first look at that chest! unipolar, 5 a wires, etc etc etc. usually if they are having prob with the standard setup capturing then they start putting all kinds of things in there. I would ask where you work if you work in that area, to see what the norm is.