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

2011; Wiley; Volume: 34; Issue: 3 Linguagem: Inglês

10.1111/j.1540-8159.2010.02972.x

1540-8159

Syed S Raza, Jianming Li, Ranjit John, Lin Y. Chen, Venkatakrishna N. Tholakanahalli, Mackenzie Mbai, Selçuk Adabağ,

Cardiac Structural Anomalies and Repair

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.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.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).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.