Permanent Pacemaker Implantation Early After Cardiac Surgery: A Descriptive Study of Pacemaker Utility After One Year of Follow-Up

• Published in: Journal of cardiac surgery Vol. 31; no. 3; pp. 132 - 138
• Main Authors: Patel, Ajay M., Verma, Dhruv, Jiang, Sheng-Fang, Lau, Kimberly Y., Arrellano, Jerry L., Cain, Brian S., Zaroff, Jonathan G.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Heart Block - therapy; Humans; Male; Middle Aged; Observational Studies as Topic; Pacemaker, Artificial - utilization; Postoperative Complications - therapy; Retrospective Studies; Time Factors; Young Adult
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.12680

Background Complete heart block (CHB) is a common complication of cardiac surgery, which may resolve spontaneously. The optimal number of days to wait for resolution of CHB prior to proceeding with a permanent pacemaker (PPM) and the long‐term utility of PPMs placed in this setting remain uncertain. Methods and results This was a retrospective cohort study, which included members of Kaiser Permanente Northern California who had cardiac surgery, a PPM placed within 30 days after surgery, and one year of follow‐up time. Chart review was performed to determine the frequency of ventricular pacing at each PPM interrogation visit up to one year after surgery. A PPM was categorized as underutilized at the time of an interrogation if none of the following were present: underlying rhythm <40 bpm, persistent CHB, or >1% ventricular pacing. The study included 247 patients with a mean time from cardiac surgery to PPM of 6.5 days. In 33 cases (13%), underutilized status was confirmed. The time from surgery to PPM implant was significantly higher in the underutilized group (8.1 ± 4.2 days vs. 6.2 ± 4.2 days, p = 0.003). Conclusions The majority of PPMs placed early after cardiac surgery are not underutilized. In this retrospective, observational study, longer delay from surgery to PPM implantation was not associated with a greater likelihood that the PPM would be utilized long term. A prospective study is required to determine optimal timing of PPM implantation in this setting. doi: 10.1111/jocs.12680 (J Card Surg 2016;31:132–138)