Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery

Moskowitz, Gil; Hong, Kimberly N.; Giustino, Gennaro; Gillinov, A. Marc; Ailawadi, Gorav; DeRose, Joseph J.; Iribarne, Alexander; Moskowitz, Alan J.; Gelijns, Annetine C.; Egorova, Natalia

doi:10.1016/j.jacc.2019.08.1064

Cited by 60 publications

(50 citation statements)

References 23 publications

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“…In our study, BRFA did not signi cantly increase the rate of PPI after surgery, which may be due to the fact that our surgeon was particularly careful to avoid damage of the atrioventricular node in the ablation area. The requirement for PPM has been reported to range from 4.5% to 13.3% in several studies [22][23] [24]. In our cohort, 9.52% of patients received a PPM in the 6 months after surgery, which matched with the previous studies mentioned above.…”

Section: Discussionsupporting

confidence: 86%

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Lin

Luo

et al. 2020

Preprint

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Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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Section: Discussionsupporting

confidence: 86%

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Lin

Luo

et al. 2020

Preprint

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“…In this context, prior work has shown that patients who develop a late requirement for PPM after valve surgery have more comorbidity associated with an increased risk for heart block and bradycardia unrelated to surgery. 20 In our population, when comorbidity was updated timedependently throughout follow-up, the hazard ratios of heart failure associated with late implantation of PPM was mitigated, supporting that the indication (opposite to the PPM placement) that was associated with increased heart failure risk. Other important differences between our study and the study by DeRose et al 23 include our analysis being restricted to patients without heart failure at baseline, whereas in the population by DeRose et al, 23 almost half of all patients had preoperative heart failure.…”

Section: Discussionsupporting

confidence: 57%

Long‐term risk of heart failure and mortality following mitral valve surgery in patients with and without right ventricular pacemaker

et al. 2020

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Objectives Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. Methods Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long‐term risks of HF and mortality was investigated by multivariable Cox regression models. Results Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30‐day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow‐up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable‐adjusted models, the hazard ratios associated with PPM were 1.00 (0.78‐1.30), P = .93 for HF, and .96 (0.76‐1.21), P = .72 for mortality. Conclusions Postoperative implantation of a permanent RV pacemaker does not alter the long‐term risks of HF and mortality following mitral valve surgery.

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“…The incidence of postprocedural PPM implantation may range from 4.3% to 30% in different patient populations underwent transcatheter or surgical PV replacement 3,12‐14 . This rate can even mount to as high as 39% in patients underwent TAVR with the CoreValve system according to Fraccaro's research 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Atrioventricular heart block is a common complication in patients received prosthetic valve (PV) implantation. The incidences ranging from 5% to 30% in patients underwent transcatheter aortic valve replacement (TAVR), approximately 5% to 10% in patients received surgical aortic valve replacement (SAVR), about 27% in patients following surgical tricuspid valve replacement (TVR) and 4.5% to 10.5% in patients underwent mitral valve repairmen (MVr) or mitral valve replacement (MVR) 1‐4 . It is widely known that conduction abnormalities (CAs) and right ventricular pacing (RVP) subsequently to PV implantation may induce electrical asynchrony, cardiac contraction asynchrony, atrial fibrillation (AF), heart failure, and early or late all‐cause mortality during short‐term or long‐term observation 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

Guo

Xiao

et al. 2020

Clinical Cardiology

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Background: Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. Objective: The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. Methods: LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. Results: LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ± 6.8 ms and 65.5 ± 5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51 ± 0.15 V@0.4 ms while the unipolar bundle capture threshold was 0.84 ± 0.51 V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ± 9.2 min and 81.7 ± 8.3 mGy, respectively. The average follow-up period was 10.4 ± 5.9 months (range 3-23 months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. Conclusions: LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups. K E Y W O R D S left bundle branch pacing, permanent pacemaker implantation, physiological pacing, prosthetic valves 1 | INTRODUCTION Atrioventricular heart block is a common complication in patients received prosthetic valve (PV) implantation. The incidences ranging Jincun Guo and Linlin Li contributed equally to this work.

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Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery

Cited by 60 publications

References 23 publications

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Long‐term risk of heart failure and mortality following mitral valve surgery in patients with and without right ventricular pacemaker

Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation

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