Address for reprints: Selcuk Adabag, M.D., Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417, Fax: 612-727-5668; e-mail: [email protected]

Conflicts of Interest: None of the authors had any conflicts of interest to declare in relation to this project.

Read the full text

About

PDF

Tools

Share a link

Email
Wechat
Bluesky

Abstract

Background: Approximately 20,000 permanent pacemakers (PPMs) are implanted annually for bradycardia or atrioventricular (AV) block after cardiac surgery. Little is known about the long-term pacing and mortality outcomes and the temporal trends of these patients.

Methods: We examined 6,268 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center between 1987 and 2010. Patients who had a PPM within 30 days of cardiac surgery were identified. Pacemaker interrogation records were retrospectively reviewed and mortality was ascertained.

Results: Overall, 141 (2.2%) patients underwent PPM implantation for high-degree AV block (55%) and bradycardia (45%), 9 ± 6 days after surgery. Age, diuretic use, cardiopulmonary bypass time (CPBT), and valve surgery were independent predictors of PPM requirement. After 5.6 ± 4.2 years of follow-up, 40% of the patients were PPM dependent. Longer CPBT (P = 0.03), PR interval >200 ms (P = 0.03), and QRS interval > 120 ms (P = 0.04) on baseline electrocardiogram predicted PPM dependency . In univariable analysis, PPM patients had a higher long-term mortality than those without PPM (45% vs 36%; P = 0.02). However, after adjusting for age, sex, type of surgery, and CPBT, PPM requirement was not associated with long-term mortality (hazard ratio 1.3; 95% confidence interval 0.9–1.9; P = 0.17). Compared to before, incidence of PPM implantation increased after the year 2000 (1.9% vs 2.6%; P = 0.04).

Conclusion: The majority of patients who require PPM after cardiac surgery are not PPM dependent in the long term. Requiring a PPM after surgery is not associated with long-term mortality after adjustment for patient-related risk factors and cardiac surgical procedure. (PACE 2011; 34:331–338)

References

1 Goldman BS, Hill TJ, Weisel RD, Scully HE, Mickleborough LL, Pym J, Baird RJ. Permanent cardiac pacing after open-heart surgery: Acquired heart disease. Pacing Clin Electrophysiol 1984; 7: 367–371.
10.1111/j.1540-8159.1984.tb04919.x
CAS PubMed Web of Science® Google Scholar
2 Caspi J, Amar R, Elami A, Safadi T, Merin G. Frequency and significance of complete atrioventricular block after coronary artery bypass grafting. Am J Cardiol 1989; 63: 526–529.
10.1016/0002-9149(89)90893-X
CAS PubMed Web of Science® Google Scholar
3 Keefe DL, Griffin JC, Harrison DC, Stinson EB. Atrioventricular conduction abnormalities in patients undergoing isolated aortic or mitral valve replacement. Pacing Clin Electrophysiol 1985; 8: 393–398.
10.1111/j.1540-8159.1985.tb05777.x
CAS PubMed Web of Science® Google Scholar
4 Baerman JM, Jirsh MM, De Buitler M, et al. Natural history and determinants of conduction defects following coronary artery bypass surgery. Ann Thorac Surg 1987; 44: 150–153.
10.1016/S0003-4975(10)62027-9
CAS PubMed Web of Science® Google Scholar
5 Kim MH, Deeb GM, Eagle KA, Bruckman D, Pelosi F, Oral H, Sticherling C, et al. Complete atrioventricular block after valvular heart surgery and the timing of pacemaker implantation. Am J Cardiol 2001; 87: 649–651.
10.1016/S0002-9149(00)01448-X
CAS PubMed Web of Science® Google Scholar
6 Meimoun P, Zeghdi R, D’Attelis N, Berrebi A, Braunberger E, Deloche A, Fabiani JN, et al. Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. Am J Cardiol 2002; 89: 1062–1066.
10.1016/S0002-9149(02)02276-2
PubMed Web of Science® Google Scholar
7 Lloyd-Jones D, Robert J, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, et al. Heart disease and stroke statistics 2010 update: A report from the American Heart Association. Circulation 2010; 121: e46–e21.
PubMed Web of Science® Google Scholar
8 Gordon RS, Ivanov J, Cohen G, Ralph-Edwards AL. Permanent cardiac pacing after a cardiac operation: Predicting the use of permanent pacemakers. Ann Thorac Surg 1998; 66: 1698–1704.
10.1016/S0003-4975(98)00889-3
CAS PubMed Web of Science® Google Scholar
9 Jaeger FJ, Trohman RG, Brener S, Loop F. Permanent pacing following repeat cardiac valve surgery. Am J Cardiol 1994; 74: 505–507.
10.1016/0002-9149(94)90916-4
CAS PubMed Web of Science® Google Scholar
10 Emlein G, Huang SK, Pires LA, Rofino K, Okike OK, Vander Salm TJ. Prolonged bradyarrythmias after isolated coronary artery bypass graft surgery. Am Heart J 1993; 126: 1084–1090.
10.1016/0002-8703(93)90658-V
CAS PubMed Web of Science® Google Scholar
11 Mosseri M, Meir G, Lotan C, Hasin Y, Applebaum A, Rosenheck S, Shimon D, et al. Coronary pathology predicts conduction disturbances after coronary artery bypass grafting. Ann Thorac Surg 1991; 51: 248–252.
10.1016/0003-4975(91)90796-S
CAS PubMed Web of Science® Google Scholar
12 Koplan BA, Stevenson WG, Epstein LM, Aranki SF, Maisel WH. Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery. J Am Coll Cardiol 2003; 41: 795–801.
10.1016/S0735-1097(02)02926-1
PubMed Web of Science® Google Scholar
13 Nishimura RA, Callahan MJ, Holmes DR Jr, Gersh BJ, Driscoll DJ, Trusty JM, Danielson GK, et al. Transient atrioventricular block after open-heart surgery for congential heart disease. Am J Cardiol 1989; 53: 198–201.
10.1016/0002-9149(84)90710-0
Web of Science® Google Scholar
14 Squarcia U, Merideth J, McGoon DC, Weidman WH. Prognosis of transient atrioventricular conduction disturbances complicating open heart surgery for congential heart defects. Am J Cardiol 1971; 28: 648–652.
10.1016/0002-9149(71)90052-X
CAS PubMed Web of Science® Google Scholar
15 Adabag AS, Wassif HS, Rice K, Mithani S, Johnson D, Bonawitz-Conlin J, Ward HB, et al. Preoperative pulmonary function and mortality after cardiac surgery. Am Heart J 2010; 159: 691–697.
10.1016/j.ahj.2009.12.039
PubMed Web of Science® Google Scholar
16 Mithani AS, Akbar MS, Johnson DJ, Kuskowski M, Apple KK, Bonawitz-Conlin J, Ward HB, et al. Dose dependent effect of statins on postoperative atrial fibrillation after cardiac surgery among patients treated with beta blockers. J Cardiothorac Surg 2009; 4: 61–67.
10.1186/1749-8090-4-61
PubMed Google Scholar
17 Grover FL, Johnson RR, Shroyer AL, Marshall G, Hammermeister KE. The veterans affairs continuous improvement in cardiac surgery study. Ann Thorac Surg 1994; 58: 1845–1851.
10.1016/0003-4975(94)91725-6
CAS PubMed Web of Science® Google Scholar
18 Adabag AS, Rector T, Mithani S, Harmala J, Ward HB, Kelly RF, Nguyen JT, et al. Prognostic significance of elevated cardiac troponin i after heart surgery. Ann of Thorac Surg 2007; 83: 1744–1750.
10.1016/j.athoracsur.2006.12.049
PubMed Web of Science® Google Scholar
19 Fisher SG, Weber L, Goldberg J, Davis F. Mortality ascertainment in the veteran population: Alternatives to the National Death Index. Am J Epidemiol 1995; 141: 242–250.
10.1093/oxfordjournals.aje.a117426
PubMed Web of Science® Google Scholar
20 Merin O, Ilan M, Oren A, Fink D, Deeb M, Bitran D, Silberman S. Permanent pacemaker implantation following cardiac surgery: Indications and long-term follow-up. Pacing Clin Electrophysiol 2009; 32: 7–12.
10.1111/j.1540-8159.2009.02170.x
CAS PubMed Web of Science® Google Scholar
21 Onalan O, Crystal A, Lashevsky I, Khalameizer V, Lau C, Goldman B, Fremes S, et al. Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up. Am J Cardiol 2008; 101: 203–208.
10.1016/j.amjcard.2007.07.062
PubMed Web of Science® Google Scholar
22 Glikson M, Dearani JA, Hyberger LK, Schaff HV, Hammill SC, Hayes DL. Indications, effectiveness, and long-term dependency in permanent pacing after cardiac surgery. Am J Cardiol 1997; 80: 1309–1313.
10.1016/S0002-9149(97)00671-1
CAS PubMed Web of Science® Google Scholar
23 Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) trial. JAMA 2002; 288: 3115–3123.
10.1001/jama.288.24.3115
PubMed Web of Science® Google Scholar
24 Ozcan C, Jahangir A, Friedman PA, Pomerantzeff PM, Spina GS, Sampaio RO, Tarasoutchi F, et al. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation. N Engl J Med 2001; 344: 1043–1051.
10.1056/NEJM200104053441403
CAS PubMed Web of Science® Google Scholar
25 Azevedo CF, Nigri M, Higuchi ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol 2010; 56: 278–287.
10.1016/j.jacc.2009.12.074
PubMed Web of Science® Google Scholar
26 Fukuda T, Hawley RL, Edwards JE. Lesions of conduction tissue complicating aortic valve replacement. Chest 1976; 69: 605–614.
10.1378/chest.69.5.605
CAS PubMed Web of Science® Google Scholar
27 Davies M, Harris A. Pathological basis of primary heart block. Br Heart J 1969; 31: 219–226.
10.1136/hrt.31.2.219
CAS PubMed Web of Science® Google Scholar
28 Utley JR, Leyland SA, Nguyenduy T. Comparison of outcomes with three atrial incisions for mitral valve operations. J Thorac Cardiovasc Surg 1995; 109: 582–587.
10.1016/S0022-5223(95)70292-X
CAS PubMed Web of Science® Google Scholar
29 Totaro P, Calamai G, Montesi G, Barzaghi C, Vaccari M. Continuous suture technique and impairment of the atrioventricular conduction alter aortic valve replacement. J Card Surg 2000; 15: 418–422.
10.1111/j.1540-8191.2000.tb01302.x
CAS PubMed Web of Science® Google Scholar
30 Elahi M, Usmaan K. The bioprosthetic type and size influence the postoperative incident of permanent pacemaker implantation in patients undergoing aortic valve surgery. J Interv Card Electrophysiol 2006; 15: 113–118.
10.1007/s10840-006-7750-4
PubMed Web of Science® Google Scholar
31 Piazza N, Onuma Y, Jessurun E, Kint PP, Maugenest AM, Anderson RH, de Jaegere PP, et al. Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. JACC Cardiol Interv 2008; 1: 310–316.
10.1016/j.jcin.2008.04.007
PubMed Web of Science® Google Scholar
32 Bruckheimer E, Berul CL, Kopf GS, Hill SL, Warner KA, Kleinman CS, Rosenfeld LE, et al. Late recovery of surgically induced atrioventricular block in patients with congenital heart disease. J Interv Card Electrophysiol 2002; 6: 191–195.
10.1023/A:1015379903936
PubMed Web of Science® Google Scholar
33 Weindling SN, Saul JP, Gamble WJ, Mayer JE, Wessel D, Walsh EP. Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 1998; 82: 525–527.
10.1016/S0002-9149(98)00375-0
CAS PubMed Web of Science® Google Scholar
34 Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM. 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51: e1–e62.
CAS Google Scholar

Citing Literature

Volume34, Issue3

March 2011

Pages 331-338

Long-Term Mortality and Pacing Outcomes of Patients with Permanent Pacemaker Implantation after Cardiac Surgery

Abstract

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Long-Term Mortality and Pacing Outcomes of Patients with Permanent Pacemaker Implantation after Cardiac Surgery

Abstract

References

Citing Literature

References

Related

Information