Abstract
BackgroundSevere postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population.MethodsWe performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria.ResultsA total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6–72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies.ConclusionsPacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.
Highlights
Post-operative conduction disorders are a major source of morbidity and mortality after cardiac surgery
We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery
Pacemaker dependency following cardiac surgery occurs with variable frequency
Summary
Post-operative conduction disorders are a major source of morbidity and mortality after cardiac surgery. The prevalence and predictors for postoperative permanent pacemaker (PPM) implantation following cardiac surgery have been well described[2], little is known about longterm pacing requirements in this population. A proportion of patients receiving permanent pacemakers for postoperative bradyarrhythmias have been observed to spontaneously recover native conduction, obviating the continued need for pacing[3, 4]. Despite this observation, the optimal timing for PPM implantation in the postoperative setting has not been clearly defined, due in part to a poor understanding of the natural history of postoperative conduction disturbances.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
