Reducing permanent pacemaker requirements following concomitant surgery for atrial fibrillation

Abstract

The need for a permanent pacemaker after cardiac surgery is significant, and related to preexisting conduction abnormalities, the type of cardiac operation, and other factors such as advanced age. Also, concomitant surgical ablation for preexisting atrial fibrillation has been identified as a risk factor for new pacemaker implant. That need varies considerably however. The risk may increase from the national average of approximately 6-7% for all cardiac operations to 15-20% in prospective studies, but per the national database is 25% higher for concomitant ablation patients. Properly applied surgical ablation lesions should not cause heart block as there are no ablations near the atrioventricular node. There may be a lack of awareness of the location of the atrial pacemaker complex which may jeopardized by some right atrial lesions. Furthermore, the pressure for early discharge may lead to the implantation of a pacemaker before the sinus mechanism has recovered. This paper reviews the anatomy relevant to the ablation lesions sets, the literature reporting pacemaker rates, and techniques to reduce the need for a new pacemaker after ablation surgery. This article is protected by copyright. All rights reserved.