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
N1 - Copyright © 2022. Published by Elsevier Inc.
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 -