Permanent pacing following repeat cardiac valve surgery

Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve

“…The incidence of intraventricular conduction defects after surgical replacement of the aortic valve has been reported in as many as 33% of patients, and has been associated with an increased incidence of adverse events (5,6). Furthermore, a permanent pacemaker is required in approximately 3% to 8% of these patients (7)(8)(9)(10)(11)(12)(13). The occurrence of conduction abnormalities after surgical replacement of the aortic valve is not surprising when one considers the anatomical proximity of the conduction system to the aortic valve.…”

Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

“…After valve surgery and CABG bradycardia usually is caused by complete or high-degree AVB and requires permanent pacing in 2% to 4% of patients [154, 155]. After CABG surgery, permanent pacing is required for sinus node dysfunction or atrioventricular conduction disturbances in 0.8% to 3.4% of patients.…”

“…The right lateral atriotomy used in minimally invasive mitral valve operations or other transseptal superior approaches to the mitral valve can cause SSS with persistent symptomatic sinus bradycardia or junctional rhythms requiring permanent pacing. Permanent pacemakers are required more often after repeat valve surgeries (7.7% versus 2.0% after initial valve surgery) [154]. A complete heart block might also develop following an AFib catheter or surgical ablation procedure, especially when radiofrequency energy is delivered nearby the septal region [156].…”

Complete Heart Block Following Valve Surgery: Violation of the “Primum Non Nocere” Maxim or a Minor Secondary Event?

“…Postoperative heart block, necessitating pacemaker implantation, is an important morbidity that is often underemphasized in current surgical series despite published rates of 3.2–9.7% . Higher rates are reported after repeat surgery and with percutaneous procedures.…”