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American Journal of Critical Care. 2007;16: 428
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Use of AEGs Not Rare Everywhere
FINANCIAL DISCLOSURES
None reported.

I am writing in regards to the article by Miller and Drew1 on the use of atrial electrograms (AEGs) after cardiac surgery. I was intrigued by the results of the survey, which described the underuse of atrial epicardial wires to diagnose atrial arrhythmias. Working as an advanced registered nurse practitioner in a tertiary care cardiothoracic surgery unit, I have found use of AEGs to be much more prominent here than among those units surveyed.

Our complex patient population includes combined coronary artery bypass grafting and valve surgery, recurrent and multiple valve surgery patients, heart transplant, and ventricular assist device patients bridging to transplant. As recognized by the authors, these populations have an increased risk of atrial arrhythmias.

Our bedside nurses undergo a 16-week orientation in the cardiothoracic intensive care unit. The more experienced nurses mentor the newer staff members in the benefits of AEG and frequently perform an AEG before calling the surgeon or midlevel provider with an arrhythmia. AEGs also are noted to be an integral component for diagnosis by the surgical team, thereby making use of AEGs important for our nurses.

In our patient population, AEGs are used to determine which atrial arrhythmias have occurred. If the nurses have identified atrial fibrillation, they may initiate a protocol for treatment following surgery. We also see many junctional arrhythmias and atrioventricular blocks due to our multiple or recurrent valvular surgery patients. Identifying the type of arrhythmia is key to medical decision making, including which medications to use and whether a permanent pacemaker needs to be inserted.

Surgeons and midlevel providers in our unit rely heavily on the diagnostic value of the AEG. We have made it part of our culture and we mentor new staff both in performing AEGs and about their benefits. I agree with the authors that increased awareness about AEGs and support from the surgical team are paramount for ensuring correct, consistent AEG use.

Tonja M. Hartjes, ARNP, MSN, BC
University of Florida at Shands, Gainesville, Florida

REFERENCE

  1. Miller J, Drew B. Atrial electrograms after cardiac surgery: survey of clinical practice. Am J Crit Care. 2007;16:350–359.[Abstract/Free Full Text]




This Article
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