Abstract
AimsThe aim of this study was to evaluate the incidence of permanent pacemaker (PPM) implantation after cardiac surgery in our institution and investigate risk factors for PPM dependency to provide patients with accurate incidence figures at the time of consent for surgery.MethodsData was collected retrospectively from a single tertiary institution from October 2018 to April 2019 inclusive of 403 patients. Incidence of PPM implantation after various cardiac operations was evaluated. A univariate analysis was carried out to identify the independent risk factors related to PPM implantation.ResultsTen patients required a PPM (2.48%). The most common indication for PPM implantation post-cardiac surgery was complete heart block (N = 7, 70%) followed by bradycardia/pauses (N = 2, 20%) and sick sinus syndrome (N = 1, 10%). PPM implantation after coronary artery bypass graft (CABG) surgery was the lowest (0.63%), while combined CABG and valve operations had the highest incidence (5.97%). Independent risk predictors for PPM implantation included female gender (p = 0.03), rheumatic heart disease (p = 0.008), pulmonary hypertension (p = 0.01), redo operations (p = 0.002), mitral valve procedures (p = 0.001), tricuspid valve procedures (p = 0.0003) and combined mitral and tricuspid valve procedures (p = 0.0001). Average length of intensive care unit (ICU)/high-dependency unit (HDU) stay was significantly prolonged for patients who required a PPM post-cardiac surgery.ConclusionAs clinicians, it can be challenging to provide our patients with accurate information on the risk of PPM implantation relative to their operation. A unit-specific data may be a more accurate method of informing our patients on this risk.
Highlights
The prevalence of permanent pacemaker (PPM) implantation following cardiac surgery had been reported to be between 0.4 and 6%, with the lowest incidence following coronary artery bypass grafting (CABG) and the highest following valve surgery [1, 2]
We aim to evaluate the incidence of PPM insertion in a single tertiary cardiothoracic centre, examining our contemporary PPM implantation rates relative to those reported in the literature
We aim to identify the risk factors for PPM insertion in our cohort of patients and its impact on our patients’ length of intensive care unit (ICU)/ high-dependency unit (HDU) stay
Summary
The prevalence of permanent pacemaker (PPM) implantation following cardiac surgery had been reported to be between 0.4 and 6%, with the lowest incidence following coronary artery bypass grafting (CABG) and the highest following valve surgery [1, 2]. Common indications for PPM post-cardiac surgery include bradyarrhythmias, such as atrioventricular (AV) block, sinus node dysfunction and atrial fibrillation (AF) with a slow ventricular response [3] These arrhythmias can occur secondary to myocardial injury that is sustained during the operation, resulting in damage to the conduction system of the heart. Previous studies have identified various preoperative risk factors associated with PPM dependency, such as advanced age, female gender, redo operations, prior valve surgery and pre-existing conduction abnormalities, PR interval > 200 ms or left bundle branch blocks (LBBB) [2, 5]. Identification of those at high risk of conduction abnormalities would allow clinicians to accurately consent patients for potential PPM insertion and may help
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