Atrial Electrograms After Cardiac Surgery: Survey of Clinical Practice

Abstract

BACKGROUND: The American Heart Association 2004 practice standards for electrocardiographic monitoring in hospitals recommend that nurses record an atrial electrogram whenever tachycardia of unknown origin develops in a patient after cardiac surgery. An atrial electrogram can be recorded from atrial epicardial pacemaker wires left in place following surgery. Because surgical practices have changed in recent years (earlier extubation and mobilization, shorter stays), it is unclear whether epicardial wires are still readily available to record an atrial electrogram. OBJECTIVE: To determine current practices in recording atrial electrograms. METHODS: A convenience sample of nurses subscribing to the American Association of Critical-Care Nurses electronic newsletter was surveyed. RESULTS: The sample comprised 247 nurses who worked in an intensive or progressive care unit in which patients were treated after cardiac surgery. Respondents were from 41 states and 139 cities. Nearly 90% of respondents had more than 5 years' nursing experience; 75% had more than 5 years' experience caring for patients after cardiac surgery. Although 92.1% of respondents reported that atrial epicardial pacing wires were left in place after cardiac surgery, only 10.2% recorded atrial electrograms often, and more than 30% had never recorded one. Analysis of written comments indicated that atrial electrograms are rarely used. Among nurses who had recorded an atrial electrogram, recordings were made about equally with a standard 12-lead electrocardiography machine and a bedside cardiac monitor. CONCLUSIONS: Although atrial epicardial pacemaker wires are often available for recording atrial electrograms, few nurses use apical epicardial wires for atrial electrograms to analyze arrhythmias.