Determinants of Pacemaker Dependency After Coronary and/or Mitral or Aortic Valve Surgery With Long-Term Follow-Up

Özer, Orhan; Crystal, Alexander; Lashevsky, Ilan; Khalameizer, Vladimir; Lau, Ching; Goldman, Bernard S.; Fremes, Stephen E.; Newman, David; Lukomsky, Maria; Crystal, Eugene

doi:10.1016/j.amjcard.2007.07.062

Cited by 46 publications

(44 citation statements)

References 18 publications

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“…Because most PPIs were implanted as a result of a high degree of or complete AVB, this observation suggests that a significant proportion of AVBs have resolved over time. This is consistent with the situation observed after surgical aortic valve replacement, 28,29 and in fact, current surgical guidelines recommend the implantation of a permanent pacemaker in patients with postoperative AVB only if the conduction abnormality persists at least 7 days after cardiac surgery or is not expected to resolve.…”

Section: Ppi After Tavi and Clinical Outcomessupporting

confidence: 64%

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

et al. 2014

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T ranscatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with aortic stenosis who are considered to be nonoperable and a good alternative for those at high surgical risk.1 However, the occurrence of some periprocedural complications remains a concern. The need for permanent pacemaker implantation (PPI) after the procedure is one of the most frequent complications associated with TAVI, with an overall incidence of ≈15% (≈25% and 7% after TAVI with self-expandable valves [SEVs] and balloon-expandable valves [BEVs], respectively). 1 Clinical Perspective on p 1243Strong evidence supports the potential negative impact of right ventricular apical pacing, which has been associated with an increased rate of the combined end point of mortality and rehospitalization for heart failure in patients with left ventricular dysfunction, 2-4 ventricular tachyarrhythmias, 5,6 and pacing-induced cardiomyopathy in patients without overt structural heart disease. 7 However, evidence for the clinical impact of PPI after TAVI remains scarce and based on small Background-Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. =0.121). Conclusions-The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death.

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Section: Ppi After Tavi and Clinical Outcomessupporting

confidence: 64%

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

et al. 2014

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“…Despite a more liberal approach to early implantation in our patients, we did not see a correlation between timing of pacemaker implantation to late dependency. Others have found a 65% 16 and 41% 17 rate of late dependency after CABG, and 49% after AVR. In our series, late dependency was 67% and 61% after non‐AVR and AVR, respectively.…”

Section: Discussionmentioning

confidence: 95%

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long‐Term Follow‐Up

Merin¹,

Ilan

Oren

et al. 2008

Pacing Clinical Electrophis

101

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(PACE 2009; 32:7-12) permanent pacemaker, cardiac surgery IntroductionThe incidence of conduction disturbance requiring pacing after open heart operations is between 10% and 15%. [1][2][3][4] Most of these will recover, however, 1-3% of patients will require permanent pacemaker implantation. [5][6][7] We reviewed our experience with permanent pacemaker (PPM) implantation following cardiac surgery. Our aim was to identify predictors for PPM requirement and identify patients who will remain pacemaker dependent over long term.

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“…Prior studies have investigated the determinants of permanent pacemaker placement in acute settings, most notably following cardiac surgery8,15 or acute myocardial infarction 7. However, the vast majority of pacemakers are not implanted in these situations but, rather, for conditions such as sinoatrial and atrioventricular nodal dysfunction that tend to develop over time – often among apparently healthy individuals 4,16.…”

Section: Discussionmentioning

confidence: 99%

Relation of QRS Width in Healthy Persons to Risk of Future Permanent Pacemaker Implantation

Cheng

Larson

Keyes

et al. 2010

The American Journal of Cardiology

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In the setting of acute myocardial infarction, prolongation of the QRS interval on an electrocardiogram identifies patients at risk of needing permanent pacemaker implantation. However, the implications of a prolonged QRS in healthy individuals are unclear, especially since the QRS prolongation encountered in this setting is typically mild. We studied the relation between QRS duration and incident pacemaker implantation in a community-based cohort of 8,311 individuals (mean age 54 years, 55% women) who attended 17,731 routine examinations with resting 12-lead electrocardiography. QRS duration was analyzed as both a continuous and categorical variable (<100 milliseconds [ms]; 100 to <120 ms; ≥120 ms). During up to 35 years of follow up, 157 participants (56 women) developed need for a permanent pacemaker. In multivariable Cox regression models adjusting for cardiovascular risk factors and prior or incident myocardial infarction or heart failure, mild QRS prolongation was associated with a 3-fold risk of pacemaker implantation (adjusted hazards ratio [HR] 2.90; 95% confidence interval [CI] 1.81–4.66; P<0.0001), and bundle-branch block was associated with a 4-fold risk of pacemaker implantation (HR 4.43; 95% CI 2.94–6.68; P<0.0001). Each standard deviation increment in QRS duration (11 ms) was associated with an adjusted hazards ratio of 1.14 (95% CI 1.11–1.18; P<0.0001) for pacemaker placement. This association remained significant after excluding individuals with QRS ≥120 ms. In conclusion, individuals with a prolonged QRS duration, even without bundle-branch block, are at increased risk for future pacemaker implantation. Such individuals may warrant monitoring for progressive conduction disease.

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Determinants of Pacemaker Dependency After Coronary and/or Mitral or Aortic Valve Surgery With Long-Term Follow-Up

Cited by 46 publications

References 18 publications

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long‐Term Follow‐Up

Relation of QRS Width in Healthy Persons to Risk of Future Permanent Pacemaker Implantation

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