I greatly enjoyed the very valuable review article, “The
Postpneumonectomy State” by Kopec and colleagues.1
I noted that in the section on cardiovascular complications, the
authors referred to the risk of hypotension and bradycardia as a result
of the medical treatment of arrhythmias following pneumonectomy. For
the last several years, I have been suturing temporary atrial and
ventricular pacemaker wires on the surface of the heart after
pneumonectomy to help in the management of postoperative arrhythmias.
The wires can be used to help in the diagnosis of complex arrhythmias,
and they can be used for overdrive pacing in the routine treatment of
bradyarrhythmias. They are easily removed when they are no longer
Correspondence to: Alan S. Coulson, MD, FCCP, Linacia
Building, 420 West Acacia Street, Suite 12, Stockton, CA 95203
We greatly appreciate Dr. Coulson’s kind remarks concerning our
review. The section of our review article1-1 that Dr.
Coulson is referring to has to do with the use of different medications
to prevent arrhythmias after pneumonectomy. Studies examining the use
of prophylactic treatment to prevent arrhythmias after pneumonectomy
have failed to demonstrate any clear beneficial agent. Specifically, we
mentioned a prospective study comparing verapamil and
placebo.1-2 The patients receiving verapamil had no
significant decrease in developing arrhythmias compared to the group
receiving a placebo, but had a 9% and 14% incidence of bradycardia
and hypotension, respectively. Two prospective studies suggest that
diltiazem1-3 or flecainide1-4 may be beneficial,
but both studies contained too small number of patients to be
Dr. Coulson suggests the routine use of pacemaker wires to treat
arrhythmias once they occur after pneumonectomy. To our knowledge,
there are no studies in which temporary cardiac pacemaker wires were
prophylactically placed at the time of pneumonectomy, as suggested by
Dr. Coulson, although it is a common practice after cardiac surgery.
Since this procedure is most expeditiously performed in patients
undergoing intrapericardial pneumonectomy, it is not clear if it should
be routinely performed in other types of pneumonectomy, except perhaps
in patients at high risk for developing postoperative arrhythmias.
Nevertheless, given the high mortality associated with developing
arrhythmias after pneumonectomy and the potential side effects of
medications used to treat the arrhythmias, Dr. Coulson’s idea merits
Correspondence to: Scott E. Kopec, MD, University of
Massachusetts, Department of Medicine, 55 Lake Avenue North,
Worchester, MA 01655-0330; e-mail: firstname.lastname@example.org
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