Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation

Mariusz Kowalewski; Michał Pasierski; Janina Finke; Michalina Kołodziejczak; Jakub Staromłyński; Radosław Litwinowicz; Grzegorz Filip; Adam Kowalówka; Wojciech Wańha; Przemysław Bławat; Andrzej Łoś; Sebastian Stefaniak; Wojciech Wojakowski; Marek Jemielity; Jan Rogowski; Marek Deja; Dariusz Jagielak; Krzysztof Bartus; Katarzyna Sierakowska; Silvia Mariani; Tong Li; Justine Mafalda Ravaux; Matteo Matteucci; Daniele Ronco; Federica Jiritano; Dario Fina; Gennaro Martucci; Paolo Meani; Giuseppe Maria Raffa; Pietro Giorgio Malvindi; Roberto Lorusso; Piotr Suwalski; Thoracic Research Centre

doi:10.1016/j.hrthm.2022.04.007

Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation

Mariusz Kowalewski^*, Michał Pasierski, Janina Finke, Michalina Kołodziejczak, Jakub Staromłyński, Radosław Litwinowicz, Grzegorz Filip, Adam Kowalówka, Wojciech Wańha, Przemysław Bławat, Andrzej Łoś, Sebastian Stefaniak, Wojciech Wojakowski, Marek Jemielity, Jan Rogowski, Marek Deja, Dariusz Jagielak, Krzysztof Bartus, Katarzyna Sierakowska, Silvia MarianiTong Li, Justine Mafalda Ravaux, Matteo Matteucci, Daniele Ronco, Federica Jiritano, Dario Fina, Gennaro Martucci, Paolo Meani, Giuseppe Maria Raffa, Pietro Giorgio Malvindi, Roberto Lorusso, Piotr Suwalski, Thoracic Research Centre

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Among patients referred for cardiac surgeries, atrial fibrillation (AF) is a common comorbidity and a risk factor for post-operative arrhythmias (such as sinus node dysfunction or atrioventricular heart blocks), including those requiring permanent pacemaker (PPM) implantation.

OBJECTIVE: The current study aimed to evaluate the prevalence and long-term survival of post-operative PPM implantation in patients with pre-operative AF who underwent valve surgery with or without concomitant procedures.

METHODS: Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During study period 11,949 patients underwent valvular (aortic, mitral or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to post-operative PPM status.

RESULTS: Permanent pacemaker implantation after surgery was necessary in 2.5% of patients, with a significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P<0.001), cardio-pulmonary bypass time (P=0.024) and endocarditis (P=0.014) were shown to be risk factors for PPM. Over long-term follow-up PPM was not associated with increased mortality as compared to no PPM: Hazard Ratio 0.96; 95% Confidence Intervals 0.77-1.19; P=0.679. Surgical ablation was not associated with PPM implantation; in the same time, SA improved survival regardless of PPM status (log rank P<0.001).

CONCLUSION: In patients with pre-operative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

Original language	English
Pages (from-to)	1442-1449
Number of pages	8
Journal	Heart Rhythm
Volume	19
Issue number	9
Early online date	13 Apr 2022
DOIs	https://doi.org/10.1016/j.hrthm.2022.04.007
Publication status	Published - Sept 2022

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10.1016/j.hrthm.2022.04.007

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Kowalewski, M., Pasierski, M., Finke, J., Kołodziejczak, M., Staromłyński, J., Litwinowicz, R., Filip, G., Kowalówka, A., Wańha, W., Bławat, P., Łoś, A., Stefaniak, S., Wojakowski, W., Jemielity, M., Rogowski, J., Deja, M., Jagielak, D., Bartus, K., Sierakowska, K., ... Thoracic Research Centre (2022). Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation. Heart Rhythm, 19(9), 1442-1449. https://doi.org/10.1016/j.hrthm.2022.04.007

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title = "Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation",

abstract = "BACKGROUND: Among patients referred for cardiac surgeries, atrial fibrillation (AF) is a common comorbidity and a risk factor for post-operative arrhythmias (such as sinus node dysfunction or atrioventricular heart blocks), including those requiring permanent pacemaker (PPM) implantation.OBJECTIVE: The current study aimed to evaluate the prevalence and long-term survival of post-operative PPM implantation in patients with pre-operative AF who underwent valve surgery with or without concomitant procedures.METHODS: Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During study period 11,949 patients underwent valvular (aortic, mitral or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to post-operative PPM status.RESULTS: Permanent pacemaker implantation after surgery was necessary in 2.5% of patients, with a significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P<0.001), cardio-pulmonary bypass time (P=0.024) and endocarditis (P=0.014) were shown to be risk factors for PPM. Over long-term follow-up PPM was not associated with increased mortality as compared to no PPM: Hazard Ratio 0.96; 95% Confidence Intervals 0.77-1.19; P=0.679. Surgical ablation was not associated with PPM implantation; in the same time, SA improved survival regardless of PPM status (log rank P<0.001).CONCLUSION: In patients with pre-operative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.",

author = "Mariusz Kowalewski and Micha{\l} Pasierski and Janina Finke and Michalina Ko{\l}odziejczak and Jakub Starom{\l}y{\'n}ski and Rados{\l}aw Litwinowicz and Grzegorz Filip and Adam Kowal{\'o}wka and Wojciech Wa{\'n}ha and Przemys{\l}aw B{\l}awat and Andrzej {\L}o{\'s} and Sebastian Stefaniak and Wojciech Wojakowski and Marek Jemielity and Jan Rogowski and Marek Deja and Dariusz Jagielak and Krzysztof Bartus and Katarzyna Sierakowska and Silvia Mariani and Tong Li and Ravaux, {Justine Mafalda} and Matteo Matteucci and Daniele Ronco and Federica Jiritano and Dario Fina and Gennaro Martucci and Paolo Meani and Raffa, {Giuseppe Maria} and Malvindi, {Pietro Giorgio} and Roberto Lorusso and Piotr Suwalski and {Thoracic Research Centre}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = sep,

doi = "10.1016/j.hrthm.2022.04.007",

language = "English",

volume = "19",

pages = "1442--1449",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier Science",

number = "9",

}

Kowalewski, M, Pasierski, M, Finke, J, Kołodziejczak, M, Staromłyński, J, Litwinowicz, R, Filip, G, Kowalówka, A, Wańha, W, Bławat, P, Łoś, A, Stefaniak, S, Wojakowski, W, Jemielity, M, Rogowski, J, Deja, M, Jagielak, D, Bartus, K, Sierakowska, K, Mariani, S, Li, T, Ravaux, JM, Matteucci, M, Ronco, D, Jiritano, F, Fina, D, Martucci, G, Meani, P, Raffa, GM, Malvindi, PG, Lorusso, R, Suwalski, P & Thoracic Research Centre 2022, 'Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation', Heart Rhythm, vol. 19, no. 9, pp. 1442-1449. https://doi.org/10.1016/j.hrthm.2022.04.007

TY - JOUR

T1 - Permanent pacemaker implantation after valve and arrhythmia surgery in patients with pre-operative atrial fibrillation

AU - Kowalewski, Mariusz

AU - Pasierski, Michał

AU - Finke, Janina

AU - Kołodziejczak, Michalina

AU - Staromłyński, Jakub

AU - Litwinowicz, Radosław

AU - Filip, Grzegorz

AU - Kowalówka, Adam

AU - Wańha, Wojciech

AU - Bławat, Przemysław

AU - Łoś, Andrzej

AU - Stefaniak, Sebastian

AU - Wojakowski, Wojciech

AU - Jemielity, Marek

AU - Rogowski, Jan

AU - Deja, Marek

AU - Jagielak, Dariusz

AU - Bartus, Krzysztof

AU - Sierakowska, Katarzyna

AU - Mariani, Silvia

AU - Li, Tong

AU - Ravaux, Justine Mafalda

AU - Matteucci, Matteo

AU - Ronco, Daniele

AU - Jiritano, Federica

AU - Fina, Dario

AU - Martucci, Gennaro

AU - Meani, Paolo

AU - Raffa, Giuseppe Maria

AU - Malvindi, Pietro Giorgio

AU - Lorusso, Roberto

AU - Suwalski, Piotr

AU - Thoracic Research Centre

PY - 2022/9

Y1 - 2022/9

N2 - BACKGROUND: Among patients referred for cardiac surgeries, atrial fibrillation (AF) is a common comorbidity and a risk factor for post-operative arrhythmias (such as sinus node dysfunction or atrioventricular heart blocks), including those requiring permanent pacemaker (PPM) implantation.OBJECTIVE: The current study aimed to evaluate the prevalence and long-term survival of post-operative PPM implantation in patients with pre-operative AF who underwent valve surgery with or without concomitant procedures.METHODS: Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During study period 11,949 patients underwent valvular (aortic, mitral or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to post-operative PPM status.RESULTS: Permanent pacemaker implantation after surgery was necessary in 2.5% of patients, with a significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P<0.001), cardio-pulmonary bypass time (P=0.024) and endocarditis (P=0.014) were shown to be risk factors for PPM. Over long-term follow-up PPM was not associated with increased mortality as compared to no PPM: Hazard Ratio 0.96; 95% Confidence Intervals 0.77-1.19; P=0.679. Surgical ablation was not associated with PPM implantation; in the same time, SA improved survival regardless of PPM status (log rank P<0.001).CONCLUSION: In patients with pre-operative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

AB - BACKGROUND: Among patients referred for cardiac surgeries, atrial fibrillation (AF) is a common comorbidity and a risk factor for post-operative arrhythmias (such as sinus node dysfunction or atrioventricular heart blocks), including those requiring permanent pacemaker (PPM) implantation.OBJECTIVE: The current study aimed to evaluate the prevalence and long-term survival of post-operative PPM implantation in patients with pre-operative AF who underwent valve surgery with or without concomitant procedures.METHODS: Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During study period 11,949 patients underwent valvular (aortic, mitral or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to post-operative PPM status.RESULTS: Permanent pacemaker implantation after surgery was necessary in 2.5% of patients, with a significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P<0.001), cardio-pulmonary bypass time (P=0.024) and endocarditis (P=0.014) were shown to be risk factors for PPM. Over long-term follow-up PPM was not associated with increased mortality as compared to no PPM: Hazard Ratio 0.96; 95% Confidence Intervals 0.77-1.19; P=0.679. Surgical ablation was not associated with PPM implantation; in the same time, SA improved survival regardless of PPM status (log rank P<0.001).CONCLUSION: In patients with pre-operative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

U2 - 10.1016/j.hrthm.2022.04.007

DO - 10.1016/j.hrthm.2022.04.007

M3 - Article

C2 - 35429649

SN - 1547-5271

VL - 19

SP - 1442

EP - 1449

JO - Heart Rhythm

JF - Heart Rhythm

IS - 9

ER -