Use of temporarily placed epicardial atrial wire

electrodes for the diagnosis and treatment

of cardiac arrhythmias following
open-heart surgery
We retrospectively assessed our experience with the use of bipolar atrial epicardial wire electrodes in 70
consecutive patients following open-heart surgery. These patients, representing 1 month's experience on
one of our cardiac surgical services, are a random sample of our total experience with more than 6,000
patients in whom we have routinely placed such electrodes. The atrial wire electrodes were used
diagnostically and/or therapeutically in 57 patients a total of 139 times. In only 13 patients were the
atrial wires not used for any reason. Atrial electrograms were recorded 63 times in 34 patients, 41 times
to establish a diagnosis of an arrhythmia and 22 times to confirm the diagnosis of an arrhythmia
originally suspected from interpretation of a standard or monitor electrocardiogram (ECG). Atrial pacing
was used to treat abnormalities of rhythm or conduction or both in 75 instances in 49 of the 70 patients.
Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine
placement of atrial wire electrodes at the time of operation is indicated regardless of the nature of the
open-heart procedure or the preoperative rhythm.

Albert L. Waldo, M . D . , William A. H. MacLean, M . D . , Terry B. Cooper, M . D . ,

Nicholas T. Kouchoukos, M.D., and Robert B, Karp, M . D . , Birmingham, Ala.

9
We and others10 18 have previously reported on
several clinically effective diagnostic and therapeutic
applications of the technique of recording or pacing
from temporarily placed atrial epicardial wire elec-
trodes in patients after open-heart surgery. During the
past 5Vi years, it has been routine practice at our insti-
tution to place a pair of wire electrodes high on the
right atrial epicardium in all patients at the completion
of operation, regardless of the preoperative rhythm, the
underlying heart disease, or the nature of the open-heart
From the Departments of Medicine and Surgery and The Cardiovas-
cular Research and Training Center, University of Alabama
School of Medicine, Birmingham, Ala.
Supported in part by U.S. Public Health Service NHLBI Program
Project Grant HL11,310 and SCOR on Ischemic Heart Disease
Grant 1P17HL17667 and by a Grant-in-Aid from the American
Heart Association. Work performed during Dr. Waldo's tenure as
the Otto G. Storm Established Investigator for the American
Heart Association.
Received for publication April 25, 1978.
Accepted for publication June 6, 1978.
Address for reprints: Albert L. Waldo, M.D., UAB Medical Center,
University Station, Birmingham, Ala. 35294.
surgical procedure. Since there have been no studies
assessing the incidence of use or risks in use after
routine placement of temporary atrial wire electrodes,
and since the placement of these electrodes at the time
of operation has not been widespread elsewhere, we
undertook a study to assess the efficacy of their routine
placement. This paper will describe our experience
with their use in all patients undergoing open-heart
surgery on one of our cardiac surgical services during a
1 month period selected at random. Additionally, we
will describe an improved technique for placement of
the electrodes.
Methods
To obtain a representative sample of the diagnostic
and therapeutic use of the atrial wire electrodes, we
observed the entire postoperative course of all (70) pa-
tients undergoing open-heart surgery on one of our
cardiac surgical services during a 1 month period. To
ensure that the selection of patients did not itself intro-
duce a bias into the use of the wire electrodes, we kept
the staff caring for the patients unaware of the ongoing
study. The uses and indications for recording and/or

500 0022-5223/78/100500+06$00.60/0 © 1978 The C. V. Mosby Co.

Volume 76
Number 4
October, 1978
pacing from the atrial wire electrodes were checked
daily for each patient in the study by a research techni-
cian who was not involved in patient care. Several
months after the period of observation was completed,
the patients' records were reviewed retrospectively by
the authors.
Placement of wire electrodes. Following comple-
tion of cardiopulmonary bypass and prior to surgical
closure of the chest, a pair of Teflon-coated stainless
steel wire electrodes (Davis and Geek No. 2597-63 O
Flexon) was secured to the epicardium high on the free
wall of the right atrium. For placement of the elec-
trodes, a 1 cm. Teflon-free end of a wire is bent to form
a J hook and is passed through a loop of 5-0 silk placed
superficially in the atrial epicardium. A second wire
electrode then is placed in the same manner 0.5 to 1.0
cm. from the first wire electrode. The wires are brought
through the anterior chest wall to the right of the ster-
num, with several centimeters of wire left as slack in-
side the chest wall. Following operation, each wire
electrode is trimmed, crimped with an Amp pin, and
used for recording atrial electrograms and/or pacing the
atria. When not being used, the distal end of the wire is
electrically isolated with nonconductive tape.
Recording of atrial electrograms. For single-
channel recordings, i.e., for recording the electrogram
alone, a Hewlett-Packard Model No. 151 IB single-
channel, internally isolated electrocardiographic (ECG)
recorder was used. The right arm, left arm, right leg,
and left leg leads initially were connected in a standard
fashion to the appropriate limbs of the patient, and an
electrocardiogram was recorded. Then the right and left
arm leads were removed from the limb electrodes. An
alligator clip was attached to the right arm lead and
another to the left arm lead, after which each was
clipped to one of the atrial wire electrodes. Since Lead I
is a bipolar lead, recording between the right and left
arm leads, a bipolar atrial electrogram was recorded
simply by moving the lead selector to Lead I. A unipo-
lar atrial electrogram was recorded by moving the ECG
lead selector either to Lead II or to Lead III, because
the recording is either between the right arm lead at-
tached to the wire electrode and the left leg (Lead II) or
the left arm lead attached to an atrial wire electrode and
the left leg (Lead III).
For recording a bipolar atrial electrogram simulta-
neously with one or more ECG's, either an MSC
three-channel ECG recorder or an Electronics for
Medicine DR-12 oscilloscopic recorder was used. Be-
cause neither of these recording machines was inter-
nally isolated, the bipolar atrial electrogram was intro-
duced directly into one of the recording channels of
Temporary epicardial atrial wire electrodes 501
Table I. Use of temporarily placed epicardial
atrial wire electrodes in 70 consecutive
surgical patients
No. of patients
Used in 57 patients
Only to record an AEG 8
Only to pace the atria 23
To record an AEG and pace the atria 26
Used on two or more separate occasions 13
Not used 13
Legend: AEG, Atrial electrogram.
either machine through an isolated input connector
which bypassed the normal ECG input.
Results
In the 70 patients observed after operation, the
atrial wire electrodes were used diagnostically and/or
therapeutically in 57 patients (81 percent) a total of 139
times. In only 13 patients were the atrial wires not used
for any reason. Table I summarizes the over-all use of
the bipolar atrial wire electrodes. The incidence and
type of postoperative arrhythmias did not correlate with
the presence or absence of preoperative arrhythmias,
the nature of the underlying heart disease, or the type of
open-heart operation performed.
Use of atrial electrograms for diagnosis of cardiac
arrhythmias. Atrial electrograms were recorded 63
times in 34 of the 70 patients. They were recorded 41
times to establish the diagnosis of an arrhythmia and 22
times to confirm the diagnosis of an arrhythmia origi-
nally suspected from interpretation of a standard or
monitor ECG. The atrial wire electrodes were not used
for diagnostic puproses in 36 patients. Table II lists the
examples in which the atrial epicardial electrodes were
used for diagnostic purposes.
Use of atrial pacing for diagnosis of abnormalities
of rhythm and conduction. Atrial pacing was used to
establish the diagnosis of atrioventricular (AV) junc-
tional rhythm in three instances, the differential diag-
nosis including sinus rhythm with first-degree heart
block and a slow supraventricular re-entrant rhythm.
Atrial pacing was used in the diagnosis of paroxysmal
atrial tachycardia in two instances, the differential
diagnosis lying between sinus tachycardia and AV
junctional tachycardia. Atrial pacing also was used to
assess AV conduction abnormalities in two patients. In
each instance, the patient had previously demonstrated
a degree of abnormal AV conduction which appeared
to have resolved. Atrial pacing at incremental rates
above the spontaneous sinus rate demonstrated normal
 The Journal of
5 0 2 Waldo et al. Thoracic and Cardiovascular
Surgery

Table II. Diagnoses obtained by use of atrial wire Table HI. Reasons for pacing treatment using wire
electrodes in 70 consecutive surgical patients electrodes in 70 consecutive surgical patients
Diagnosis Atrial Ventricular
Rhythm disturbance pacing pacing*
Rhythm Primary Confirm
Sinus bradycardia (<80 beats/min.) 24 1
Premature atrial beats 2 0 Premature atrial beats 11 0
Premature ventricular beats 5 1 Premature ventricular beats 22 2
Atrial fibrillation 5 6 AV junctional rhythm 3 1
Atrial flutter 6 1 Atrial fluttert 6 0
PAT, Atrial tachycardia 3 0 Paroxysmal atrial tachycardia! 2 0
Aberrant AV conduction 1 0 Atrial tachycardiat 1 0
AV junctional rhythm 5 1 Ventricular tachycardia 2 2
Ventricular tachycardia 1 0 AV dissociation 2 1
AV dissociation 2 2 Second degree AV block 2 1
Normal sinus rhythm 5 8
AV block* 2 0 Totals* 75 8
Othert 4 3 ♦Demand mode ventricular pacing excluded.
Totals* 41 22 tRapid atrial pacing to intemipt arrhythmia, or continuous rapid atrial pacing
to suppress recurrent arrhythmia.
Legend: PAT, Paroxysmal atrial tachycardia. AV, Atrioventricular. $Twenty-one patients had no indication for cardiac pacing. Eighteen patients
* Atrial pacing used to assess AV conduction. had two or more indications for cardiac pacing.
tSinus bradycardia, atrial bigeminy, sinus tachycardia, and atrial standstill.
^Thirty-six patients had no indication for recording an atrial electrogram.
Thirteen patients had two or more indications for recording an atrial elec- Morbidity and mortality associated with use of
trogram. epicardial electrodes. All wire electrodes remained in
place until they were removed with a gentle tug the
1:1 AV conduction up to very rapid rates in each in- night before each patient was to be discharged. No
stance, which illustrates that there was no apparent re- complications and minimal discomfort accompanied
sidual AV conduction abnormality. this brief maneuver.
Use of atrial pacing for treatment of abnor- Illustrative examples of use of atrial wire elec-
malities of rhythm and conduction. Atrial pacing was trodes. Representative examples of the use of the atrial
used to treat abnormalities of rhythm and conduction 75 wire electrodes in three patients will serve to illustrate
times in 49 of the 70 patients (Table III). The reasons the great clinical value of the atrial recording and pac-
for atrial pacing are self-explanatory in most cases, but ing techniques. The first example is from a patient who
a few comments are in order. Atrial pacing at rates previously had had ectopic atrial tachycardia with vari-
between 100 and 110 beats per minute, and in one able AV block. The rhythm then was noted to have
instance up to 115 beats per minute, was used in 11 become regular at a rate of 100 beats per minute, and
patients in an effort to suppress premature atrial beats. the routine monitor ECG suggested a sinus rhythm.
In five of these 11 patients in whom the premature atrial However, when the bipolar atrial electrogram was re-
beats were not satisfactorily suppressed by atrial pac- corded simultaneously with the ECG (Fig. 1), it was
ing, even in conjunction with drug therapy such as clear that the ectopic atrial tachycardia was still pres-
quinidine and procainamide, supra ventricular tachy- ent, although now with the 2:1 AV conduction.
cardia (atrial fibrillation, atrial flutter, or paroxysmal The second example is from a patient who on differ-
atrial tachycardia) later developed. On two occasions in ent occasions manifested both ventricular and supra-
the presence of second-degree A V block, atrial pacing ventricular arrhythmias. Fig. 2 demonstrates a sinus
at a rate more rapid than the sinus rate was used to rhythm with premature beats. The simultaneously re-
increase the ventricular rate. corded bipolar atrial electrogram clearly documents
Table HI also includes instances in which ventricular that the premature beats are not of atrial origin. The
pacing treatment was used. In each instance, ventric- differential diagnosis of these premature beats rests be-
ular pacing was employed because atrial pacing either tween A V junctional and ventricular origin. Despite the
was not or would not have been effective. These data remarkable similarity between the shape of the sinus-
demonstrate that when both atrial pacing and ventric- conducted ventricular complexes and the premature
ular pacing are available for management of cardiac ventricular complexes, those premature beats proved to
arrhythmias, atrial pacing is preferable by far, but that be of ventricular origin, as they later precipitated
ventricular pacing clearly has an important clinical role ventricular tachycardia. At another time, the patient
in some patients. had premature beats and a tachycardia in which the
Volume 76
Number 4
October, 1978
Simultaneous strips
AES
^44^ty^d^y^yii4
Fig. 1. Monitored electrocardiogram (ECG) recorded simul-
taneously with a bipolar atrial electrogram (AEG) demonstrat-
ing atrial tachycardia with 2:1 atrioventricular conduction.
Paper recording speed 25 mm. per second. See text for dis-
cussion.
Fig. 2. ECG Lead II recorded simultaneously with a bipolar
atrial electrogram (AEG), permitting the diagnosis of prema-
ture-ventricular beats. Time marks are at 1 second intervals.
Paper recording speed 25 mm. per second. See text for dis-
cussion.
QRS complexes were difficult to distinguish from the
premature ventricular beats shown in Fig. 2. A bipolar
atrial electrogram recorded simultaneously with the
ECG permitted the ready diagnosis of premature atrial
beats and paroxysmal supraventricular tachycardia
(Fig. 3). Clearly, without the atrial electrogram record-
ing, the correct diagnosis from the ECG alone would
have been very difficult. The supraventricular tachy-
cardia was easily interrupted with rapid atrial pacing,
but because this tachycardia was recurrent, continuous
rapid atrial pacing was initiated to suppress the ar-
rhythmia, utilizing physiological AV conduction block
to maintain a clinically acceptable ventricular rate
(Fig. 4).
The third example presents a classical problem of the
differential diagnosis of a regular tachycardia of 130
beats per minute associated with a wide QRS complex
(Fig. 5). Simply recording a bipolar atrial electrogram
demonstrated a regular atrial rate of 100 beats per min-
ute and thereby established the presence of AV disso-
ciation and a likely diagnosis of ventricular tachy-
cardia. However, the diagnosis of an AV junctional
tachycardia with aberrant conduction was still possible.
Temporary epicardial atrial wire electrodes 50 3
HI 11' ¥'!'11H'm il1,'V1' rTTt'l'I'ITUfttffPifiT7$ Ibi
Fig. 3. ECG Lead II recorded simultaneously with a bipolar
atrial electrogram (AEG) in the same patient as in Fig. 2,
permitting the diagnosis of supraventricular tachycardia.
Times marks are at 1 second intervals. Paper recording speed
25 mm. per second. See text for discussion.
A Pacing Rate-300 V Rate-150
Fig. 4. ECG Lead II recorded during atrial pacing at 300
beats per minute, which achieved 2:1 atrioventricular con-
duction at a ventricular rate of 150 beats per minute. S, Stimu-
lus artifact. Paper recording speed 25 mm. per second. This
figure was recorded from the same patient whose records are
illustrated in Figs. 2 and 3.
The atria then were paced at a rate of 150 beats per
minute (Fig. 6). The presence of ventricular fusion
beats prior to complete atrial capture of the ventricles
documented the diagnosis of ventricular tachycardia.
Discussion
This study strongly supports the routine placement
of temporary atrial epicardial wire electrodes in all
patients undergoing open-heart operations. Their fre-
quent use, 139 times in 57 of the 70 patients (81 per-
cent) in this series, not only provides clear evidence
of their clinical usefulness, but also reflects the fact that
the diagnostic and therapeutic techniques which utilize
the atrial wire electrodes are easy, rapid, reliable, ef-
fective, and safe. Thus, as is apparent in this study,
their availability permitted the atrial wire electrodes to
be used in preference to other techniques. For instance,
atrial flutter could have been diagnosed from an ECG,
perhaps in association with carotid sinus massage, and
it could have been treated with direct-current car-
dioversion or drug therapy instead of rapid atrial pac-
ing. However, those managing the patients felt it was
simpler and/or more efficacious to use the atrial
epicardial wire electrodes. This was true not only for
instances in which the atrial wire electrodes were in-

5 0 4 Waldo et al.
Sequential strips
Fig. 5. These strips, recorded sequentially, suggest the diag-
nosis of ventricular tachycardia. The top strip is ECG Lead II.
The middle strip is a bipolar atrial electrogram. The bottom
strip is a unipolar atrial electrogram. A, Atrial complex. V,
Ventricular complex. Paper recording speed 25 mm. per sec-
ond. See text for discussion.
valuable for the diagnosis and treatment of serious or
complicated arrhythmias, but also for the diagnosis and
treatment of relatively straightforward arrhythmias.
The usefulness of the atrial wire electrodes should be
considered against the background of potential risks
associated with their use. In more than 6,000 patients in
whom these temporary atrial electrodes have been
placed in the past 5% years, we are aware of only three
"complications," each of which involved the inability
to remove a wire because it could not be pulled through
the anterior chest wall. In each instance, the wire was
simply cut at the point where it exited the chest wall.
Indications for recording atrial electrograms fol-
lowing open-heart surgery. At virtually all centers
where open-heart surgery is performed, the ECG is
monitored routinely for some period after the opera-
tion. This monitor ECG is adequate to diagnose many
of the cardiac arrhythmias which occur. However,
some are difficult and others virtually impossible to
diagnose from the ECG alone. Usual procedures rec-
ommended to diagnose arrhythmias which are not ap-
parent from a simple ECG include various vagal stimuli
such as carotid sinus massage or a Valsalva maneuver,
placement of an esophageal or transvenous catheter
electrode, attention to fourth heart sounds, and the like.
The need for any of these procedures is obviated by
recording electrograms from wire electrodes on the
atrial epicardium.
The specific indications for recording atrial electro-
grams are too numerous to mention. Clearly, they
should be recorded when the correct rhythm diagnosis
is in doubt. Additionally, as is apparent from this
study, these recordings may also be performed to es-
tablish rhythm diagnoses in preference to a standard
ECG recording.
The Journal of
Thoracic and Cardiovascular
Surgery
Continuous strips
Fig. 6. ECG Lead II recorded from the same patient whose
records are illustrated in Fig. 5. The black dot in the top strip
marks the onset of atrial pacing. The bottom strip, which is
continuous with the top strip, illustrates that fusion beats ap-
pear prior to complete atrial capture of the ventricles, thereby
permitting the diagnosis of ventricular tachycardia. S, Stimu-
lus artifact. Paper recording speed 25 mm. per second. See
text for discussion.
Indications for atrial pacing following open-heart
surgery.
For diagnosis of cardiac arrhythmias. Even when an
atrial electrogram has been recorded, atrial pacing may
still be necessary to diagnose some arrhythmias. For
instance, the classical differential diagnosis of a narrow
QRS complex tachycardia at a rate of 150 beats per
minute with a 1:1 AV relationship encompasses the
following: sinus tachycardia, AV junctional tachycar-
dia, AV nodal re-entrant tachycardia, sinus node re-
entrant tachycardia, and ectopic nonparoxysmal atrial
tachycardia. If the tachycardia of 150 beats per minute
has a wide QRS complex, the differential diagnosis
would include the just-mentioned arrhythmias in asso-
ciation with aberrant ventricular conduction or ven-
tricular tachycardia with 1:1 retrograde AV conduc-
tion. In such circumstances, atrial pacing may not only
aid in the correct diagnosis but also may provide effec-
tive therapy. 7,8
For treatment of cardiac arrhythmias. Atrial pacing
can be safely and effectively used to manage virtually
all arrhythmias except atrial fibrillation, Type II atrial
flutter, sinus tachycardia, and ventricular fibrilla-
tion.4"8 When atrial wire electrodes are available in the
postoperative period, atrial pacing becomes the treat-
ment of choice for many of these arrhythmias. 4 ' 5 * 7 ' 8
There are several clinical advantages of atrial pacing
therapy: It is immediate in effect; it frequently avoids
the need for drugs with their attendant undesirable side
effects and toxic effects; it is associated with virtually
no discomfort; when pacing therapy is no longer desir-
able, it can be terminated promptly; and finally, it may
provide a period of effective therapy during which an-
Volume 76
Number 4
October, 1978
tiarrhythmic drugs, which may be needed to provide
chronic, effective suppression of arrhythmias, can be
administered.
Placement of atrial wire electrodes. The presence
or absence of preoperative arrhythmias and the nature
of the operation provide no indication of the postopera-
tive incidence or type of arrhythmias. For example,
even patients with preoperative atrial fibrillation may
have other arrhythmias postoperatively, including su-
pra ventricular arrhythmias, for which the atrial wire
electrodes are invaluable for both diagnosis and treat-
ment. 4 Therefore, we recommend that temporary atrial
wire electrodes be placed in all patients undergoing
open-heart surgery.
There are two important clinical reasons why place-
ment of a pair of atrial wire electrodes is desirable. The
first is for use in diagnosis. If the wires are placed high
on the right atrium and the interelectrode distance is 0.5
to 1.0 cm., then the bipolar atrial electrogram will
primarily record deflections which represent atrial acti-
vation. This is particularly important in the diagnosis of
various arrhythmias in which some or all atrial activa-
tion may occur simultaneously with ventricular activa-
tion. In such instances, of which atrial flutter with 2 : 1
AV conduction is a good example, atrial activation
would be masked within the recorded ventricular com-
plex in a unipolar atrial electrogram but would be
readily identified in a bipolar atrial electrogram.
The second reason for using two wire electrodes in-
stead of one relates to therapy. During bipolar atrial
pacing, the stimulus artifact, although easily seen, does
not distort the ECG. By contrast, with unipolar atrial
pacing, the stimulus artifact greatly distorts the ECG.
This latter distortion becomes particularly important
when rapid atrial pacing techniques are being used to
treat supraventricular tachycardias, 3, 7 ' 8 because the
unipolar stimulus artifact precludes clear identification
of the P wave and prevents the examiner from knowing
whether or not atrial capture has been obtained.
REFERENCES
1 Waldo AL, Ross SM, Kaiser GA: The epicardial electro-
gram in the diagnosis of cardiac arrhythmias in the
postoperative patient. Geriatrics 26:108-112, 1971
2 Waldo AL, Vitikainen KJ, Kaiser GA, Bowman FO Jr,
Malm JR, Hoffman BF: Atrial standstill secondary to
atrial inexcitability (atrial quiescence). Circulation 46:
690-697, 1972
3 Waldo AL, Krongrad E, Kupersmith J, Levine OR,
Bowman FO Jr, Hoffman BF: Ventricular paired pacing
to control rapid ventricular heart rate following open heart
surgery. Observations on ectopic automaticity. Report of
Temporary epicardial atrial wire electrodes 505
a case in a four-month-old patient. Circulation 53:176-
181, 1976
4 Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT,
James TN: Continuous rapid atrial pacing to control re-
current or sustained supraventricular tachycardias follow-
ing open heart surgery. Circulation 54:245-250, 1976
5 Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT,
James TN: Entrainment and interruption of atrial flutter
with atrial pacing. Studies in man following open heart
surgery. Circulation 56:737-745, 1977
6 Wells JL Jr, Karp RB, Kouchoukos NT, MacLean WAH,
James TN, Waldo AL: Characterization of atrial fibrilla-
tion in man. Studies following open heart surgery. PACE
3:965-980, 1978
7 MacLean WAH, Cooper TB, Waldo AL: Use of cardiac
electrodes in the diagnosis and treatment of tachyar-
rhythmias. Cardiovasc Med (in press)
8 Cooper TB, MacLean WAH, Waldo AL: Overdrive pac-
ing for supraventricular tachycardia. A review of theoret-
ical implications and therapeutic techniques. PACE
1:196-221, 1978
9 Waldo AL, Cooper TB, MacLean WAH: Cardiac pacing
in the treatment of cardiac arrhythmias following open
heart surgery. Use of temporarily placed atrial and ven-
tricular wire electrodes, Cardiac Pacing, ed. 2, P Samet,
ed., New York and London, Grune & Stratton, Inc., in
press
10 Harris PD, Singer DH, Malm JR, Hoffman BF: Chron-
ically implanted cardiac electrodes for diagnostic, thera-
peutic, and investigational use in man. J THORAC CAR-
DIOVASC SURG 54:190-198, 1967
11 Harris PD, Malm JR, Bowman FO Jr, Hoffman BF,
Kaiser GA, Singer DH: Epicardial pacing to control ar-
rhythmias following cardiac surgery. Circulation 37:
Suppl 2:178-183, 1973
12 Litwak RS, Kuhn LA, Gadboys HL, Lukban SB, Sakurai
H: Support of myocardial performance after open cardiac
operations by rate augmentation. J THORAC CARDIOVASC
SURG 56:484-496, 1968
13 Woodson RD, Starr A: Atrial pacing after mitral valve
surgery. Arch Surg 97:894-990, 1968
14 Beller BM, Frater RWM, Wulfsohn N: Cardiac pacemak-
ing in the management of postoperative arrhythmias. Ann
Thorac Surg 6:68-78, 1968
15 Hodam RP, Starr A: Temporary postoperative epicardial
pacing electrodes. Their value and management after
open heart surgery. Ann Thorac Surg 8:506-510, 1969
16 Iwa T, Sugiki K, Todo K, Abe H, Wada J: Atrial pace-
maker (II). Jpn J Thorac Surg 24:796-802, 1971
17 Mills NL, Ochsner JL: Experience with atrial pacemaker
wires implanted during cardiac operations. J THORAC
CARDIOVASC SURG 66:878-886, 1973
18 Pittman DE, Gay TC, Patel II, JoynerCR: Termination of
atrial flutter and atrial tachycardia with rapid atrial stimu-
lation. Angiology 36:784-802, 1975