PT  - JOURNAL ARTICLE
AU  - G Limongelli
AU  - V Ducceschi
AU  - A D’Andrea
AU  - A Renzulli
AU  - B Sarubbi
AU  - M De Feo
AU  - F Cerasuolo
AU  - R Calabrò
AU  - M Cotrufo
TI  - Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience
AID  - 10.1136/heart.89.8.901
DP  - 2003 Aug 01
TA  - Heart
PG  - 901--904
VI  - 89
IP  - 8
4099  - http://heart.bmj.com/content/89/8/901.short
4100  - http://heart.bmj.com/content/89/8/901.full
SO  - Heart2003 Aug 01; 89
AB  - Objective: To identify perioperative clinical predictors of permanent pacemaker implantation following aortic valve replacement. Design and patients: Prospective cohort study on 276 patients submitted for aortic valve replacement: 267 patients (mean (SD) age, 57.5 (14) years) with no conduction disturbances, and nine patients (67.7 (5) years) with severe conduction disturbances requiring permanent pacing; 65 perioperative variables (38 preoperative, eight intraoperative, and 19 postoperative) were considered. Results: Nine patients (3.2%) had irreversible second or third degree atrioventricular (AV) block requiring permanent pacing. Risk factors for permanent pacing identified by univariate analysis were: preoperative: additional valvar disease, aortic regurgitation, myocardial infarction, pulmonary hypertension, anaemia, use of digitalis; intraoperative: cardiac arrest; postoperative: cardiac arrest, conduction disturbances, electrolytic imbalance, angiotensin converting enzyme inhibitor use. Multivariate logistic regression analysis identified preoperative aortic regurgitation (p < 0.005; odds ratio (OR) 6.6, 95% confidence interval (CI) 1.6 to 12.2), myocardial infarction (p < 0.0005; OR 15.2, 95% CI 6.3 to 19.9), pulmonary hypertension (p < 0.005; OR 12.5, 95% CI 3.2 to 18.3), and postoperative electrolyte imbalance (p < 0.01; OR 4.5, 95% CI 1.3 to 6.4). Conclusions: Irreversible AV block requiring permanent pacemaker implantation is an uncommon condition following aortic valve replacement. Previous aortic regurgitation, myocardial infarction, pulmonary hypertension, and postoperative electrolyte imbalance should be considered in order to identify patients at increased risk for advanced AV block.