Bradyarrhythmia development and permanent pacemaker implantation after cardiac surgery

Abstract

OBJECTIVE: Bradyarrhythmia is one of the complications that may develop after cardiac surgery. Only a few studies have previously dealt with this concern, and in our study, we investigated the factors affecting the development of atrioventricular block or sinus node dysfunction and the requirement of permanent pacemaker following cardiac surgery. METHODS: A total of 62 patients who developed the atrioventricular (AV) block or sinus node dysfunction and required a permanent pacemaker following cardiac surgery were included in the study. Among these, 31 patients were evaluated prospectively, and the information regarding 31 patients was evaluated retrospectively based on hospital records. Demographic, clinical, and surgical information was recorded. Patients were grouped according to the types of procedures, including the coronary artery bypass graft, valve surgery, congenital heart disease, and combinations of these. Patients were evaluated by standard 12-lead electrocardiogram and transthoracic echocardiography preoperatively. The postoperative development of bradyarrhythmia and requirement of permanent pacemaker were evaluated. RESULTS: The mean age of patients with preoperative conduction abnormality and wide QRS was statistically significantly higher than those without these disorders. The odds ratio for preoperative conduction abnormality risk in patients over 70 years of age was found as 4.429 (95% confidence interval, 1.40–13.93). There was no gender-related statistically significant difference in terms of left ventricular ejection fraction, left ventricular dilatation, interventricular septum thickness, the time interval from operation to the development of AV block, concomitant diseases, and complication rates. CONCLUSION: Preoperative conduction abnormality and wide QRS in patients over 70 years of age was determined as a risk factor.

Risk Factors and Outcomes of Permanent Pacemaker Implantation Following Aortic and Mitral Valve Replacements

“…However, Ghamdi and colleagues found that there was no difference in PPI with respect to gender. Several studies reported that older age (>75 years) was a risk factor for PPI, however, we did not find any association between the PPI and age (10,11). Moreover, patients >75 years of age and who had a wide QRS were at risk for PPI (11).…”

“…Several studies reported that older age (>75 years) was a risk factor for PPI, however, we did not find any association between the PPI and age (10,11). Moreover, patients >75 years of age and who had a wide QRS were at risk for PPI (11). The presence of arrhythmia and preoperative conduction disturbances, older age, concomitant procedures were linked to enhanced risk for PPI following heart surgery.…”

The prevalence of permanent pacemaker implantation after open-heart surgeries; eight years of experience in Tehran heart center

“…This study reported patients’ demographic, clinical, and procedural characteristics requiring PPI following open-heart surgeries. Among all our patients after open-heart surgery, we found that the prevalence of PPI was 0.53%, which is significantly lower than in other similar studies [ 3 , 11 , 20 , 21 ]. Following CABG, the rate of post-operative PPI was 0.13%, while figures of 0.73% [ 22 ], 0.9%[ 23 ], 1% [ 3 ], and 1.3%[ 24 ] were reported in other studies.…”

“…Our study had a shorter pump time and cross-clamp time (132, 84 min) in comparison with Huynh et al [ 30 ] (157, 125 min), Merin et al [ 3 ] (141, 92 min), and Raza et al [ 23 ] (168, 121 min) studies. Interstingly, PPI postoperatively is associated with prolonged pump and cross-clamp time [ 11 ]. Merin et al revealed that prolonged cross-clamp time could significantly increase the risk of PPI ( P < 0.001).…”

“…In the case of transient AVB, patients sometimes need a temporary pacemaker until the recovery of native atrioventricular conduction. However, persistent post-operative AVB necessitates treatment with interventional procedures, and if the cause of AVB is irreversible, the patient often requires PPI [ 3 , 9 – 11 ]. Over the past five decades, the development of implantable electronic devices has facilitated the management of conduction disturbances after open-heart surgeries, which have been life-saving for many patients worldwide [ 8 , 11 ].…”