Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era

Abstract

BackgroundPermanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era.MethodsAfter exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed.ResultsPatients’ mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up.ConclusionsPatients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long-term follow-up. We recommend preoperative assessment for risk of requiring postoperative PPM, to counsel patients about this risk and early PPM implantation in high-risk patients who are PPM dependent after surgery.

Incidence of Permanent Pacemaker Implantation after Cardiac Surgery: A Single Centre Experience

“…In our series the overall intrahospital PPI rate after open heart surgery was 4.2%, which is similar to published results from other institutions and registries (Al-Ghamdi et al, 2016). We observed the highest need for pacemaker im- Fig.…”

“…Cardiac conduction abnormalities after heart surgery are observed in 17% to 34% of patients. Transient bradyarrhythmias resolve themselves in the first days after surgery, but persistent conduction disturbances requiring permanent pacemaker implantation (PPI) occur in 0.4-8.5% of patients undergoing conventional heart surgery, depending on surgery type and can reach even higher frequencies after TAVI (Meimoun et al, 2002;Berdajs et al, 2008;Merin et al, 2009;Moraca et al, 2009;Schurr et al, 2010;Al-Ghamdi et al, 2016;Mangieri et al, 2018).…”

“…The incidence of postoperative PPI has a tendency to decrease, because of better understanding of the mechanisms of possible injury to the conduction system of the heart during surgery. Certain technological improvements to the procedures and to the design of implantable devices have facilitated this reduction (Nardi et al, 2010;Al-Ghamdi et al, 2016). On the other hand, the overall number of PPI after cardiac procedures has increased due to the advent of TAVI.…”

Behandlungsprinzipien in der herzchirurgischen Intensivmedizin

“…Bei etwa 0,4-6 % aller herzchirurgischen Patienten kommt es zur postoperativen Persistenz der AV-Überleitungsstörung, und diese erfordert meist nach etwa 5-7 Tagen die Implantation eines permanenten Schrittmachersystems [84].…”

Permanent pacing and conduction recovery in patients undergoing cardiac surgery for active infective endocarditis in an Australian Tertiary Center

“…recurrent blood infections. From here the need for reliable predictors of PPM implantation emerges.In patients undergoing valve surgery without IE, various preoperative and operative predictors have been studied to identify patients more likely to need PPM postoperatively earlier to reduce their hospital stay and improve the usage of hospital resources; these studies have yielded inconsistent findings 8,[13][14][15][16][17]. Examples of predictors included baseline conduction disorder, advanced age,prolonged cardiopulmonary bypass time, aortic valve surgery, and postoperative cardiac arrest.…”