Determinants of pacemaker dependency after cardiac surgery

Abstract

Conduction disorders in the postoperative period of cardiac surgery impedes prompt clinical recovery and prolongs hospitalization. The aim of this study was to identify the predictive factors of pace maker dependency in patients with high grade atrioventricular block (AVB) after cardiac surgery. A 25 patients’ descriptive retrospective study carried out in the-cardiology department of Charles Nicolle's Hospital in Tunis (Tunisia) between 1997 and 2014. We included all patients with a high-grade AVB requiring definitive pacemaker implantation following cardiac surgery. We investigated the pacemaker dependency of each patient during his last follow-up. The mean age was 44 years and 9 months. Our population was made of 14 men (56%) and 11 women. Correction of acquired heart disease was the dominant indication of operation (68%). Preoperatively, 14 patients (56%) were in sinus rhythm. A pacemaker implantation was indicted for a complete AV block in 23 patients (92%). Postoperatively, 10 patients (40%) had an immediate complete AV block. After pacemaker implantation and at the last follow-up, 9 patients were dependent of their pacemaker. The immediate occurrence of AV block is the only factor significantly correlated to the pacemaker dependency ( P = 0.041). This study highlights the importance of a regular and pronged screening of conduction disorders in patients undergoing cardiac surgery since immediate postoperative period.