Arrhythmias and Conduction Disturbances
Indications, Effectiveness, and Long-Term Dependency in Permanent Pacing After Cardiac Surgery

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Abstract

The purposes of this study were to define predictors of long-term pacemaker dependency in patients having permanent pacemakers implanted shortly after cardiac surgery, and to evaluate short- and long-term results and survival in this population. Data from 120 adult patients with implantation since 1980 were retrospectively analyzed. Acute and chronic complication rates (4.2% and 16.6%, respectively) were not higher than those expected in the general paced population. In addition, continuous rhythm was evaluated by use of pacemaker inhibition in a subgroup of 20 patients to verify the validity of clinical criteria for pacemaker dependency. Of the patients evaluated for dependency, 41% eventually became nondependent. Prolonged monitoring with an inhibited pacemaker confirmed the accuracy of our method of clinical evaluation of pacemaker dependency. Significant predictors of long-term pacemaker dependency were complete atrioventricular block as the indication and bypass time of >120 minutes (by multivariate and univariate analyses, respectively). Postoperative complete atrioventricular block is the most important predictor of pacemaker dependency, enabling an earlier decision on permanent pacemaker implantation (no later than the sixth and the ninth postoperative days for wide-complex and narrow-complex escape, respectively). Further prospective studies are needed to define optimal implantation times for indications other than complete atrioventricular block.

Section snippets

Methods

We reviewed hospital charts and outpatient clinic charts of 120 patients who had cardiac surgery at our institution during a 14-year period and had permanent pacemakers implanted within the first 40 days after the operation.

Patient and Preoperative Data:

All the inclusion criteria were met by 120 patients, who were included in the analysis. Of the patients, 57 were men and 63 women, and the median age at operation was 72 years (range 43 to 89). Twenty-five of the patients had a history of significant bradyarrhythmias (either symptomatic bradyarrhythmia or advanced atrioventricular block, pauses >3 seconds, nodal rhythm, atrial fibrillation, or sinus bradyarrhythmia <50 beats/min). All preoperative electrocardiographic patterns are listed in

Discussion

Permanent pacemakers are implanted in 0.8% to 4% of patients with postoperative bradyarrhythmias.1, 2, 3, 4, 5, 6 Risk factors that have been described in the literature for development of significant postoperative bradyarrhythmias include valvular surgery,3, 4, 5, 13 older age,1, 3 preexisting bundle-branch block,1, 3, 5 certain coronary anatomies,9, 11 certain cardioplegia solutions,7, 8, 10 and long bypass or aortic cross-clamp time.[2]

In this study, we used retrospective long-term data

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Dr. Glikson’s work was supported in part by an educational grant from Medtronic Inc., Minneapolis, Minnesota.

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