Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2003 Aug;89(8):901-4.
doi: 10.1136/heart.89.8.901.

Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience

G Limongelli  1 , V Ducceschi, A D'Andrea, A Renzulli, B Sarubbi, M De Feo, F Cerasuolo, R Calabrò, M Cotrufo
Affiliations

Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience

G Limongelli et al. Heart. 2003 Aug.

Abstract

Objective: To identify perioperative clinical predictors of permanent pacemaker implantation following aortic valve replacement.

Design and patients: Prospective cohort study on 276 patients submitted for aortic valve replacement: 267 patients (mean (SD) age, 57.5 (14) years) with no conduction disturbances, and nine patients (67.7 (5) years) with severe conduction disturbances requiring permanent pacing; 65 perioperative variables (38 preoperative, eight intraoperative, and 19 postoperative) were considered.

Results: Nine patients (3.2%) had irreversible second or third degree atrioventricular (AV) block requiring permanent pacing. Risk factors for permanent pacing identified by univariate analysis were: preoperative: additional valvar disease, aortic regurgitation, myocardial infarction, pulmonary hypertension, anaemia, use of digitalis; intraoperative: cardiac arrest; postoperative: cardiac arrest, conduction disturbances, electrolytic imbalance, angiotensin converting enzyme inhibitor use. Multivariate logistic regression analysis identified preoperative aortic regurgitation (p < 0.005; odds ratio (OR) 6.6, 95% confidence interval (CI) 1.6 to 12.2), myocardial infarction (p < 0.0005; OR 15.2, 95% CI 6.3 to 19.9), pulmonary hypertension (p < 0.005; OR 12.5, 95% CI 3.2 to 18.3), and postoperative electrolyte imbalance (p < 0.01; OR 4.5, 95% CI 1.3 to 6.4).

Conclusions: Irreversible AV block requiring permanent pacemaker implantation is an uncommon condition following aortic valve replacement. Previous aortic regurgitation, myocardial infarction, pulmonary hypertension, and postoperative electrolyte imbalance should be considered in order to identify patients at increased risk for advanced AV block.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Multivariate predictors of permanent pacing requirement following aortic valve replacement in a multivariate logistic model which included all the perioperative variables. CI, confidence interval; OR, odds ratio.
See this image and copyright information in PMC

References

    1. Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med 2000;28(suppl):N136–44. - PubMed
    1. Sloan SB, Weitz HH. Postoperative arrhythmias and conduction disorders. Med Clin North Am 2001;85:1171–89. - PubMed
    1. Baterman TM, Weiss MH, Czer LSC, et al. Fascicular conduction disturbances and ischemic heart disease: adverse prognosis despite coronary revascularization. J Am Coll Cardiol 1985;5:623–9. - PubMed
    1. Emlein G, Huang SKS, Pires LA, et al. Prolonged bradyarrhythmias after isolated coronary by-pass graft surgery. Am Heart J 1993;126:1084–90. - PubMed
    1. Blanche C, Czer LSC, Trento A, et al. Bradyarrhythmias requiring pacemaker implantation after orthotopic heart transplantation: association with rejection. J Heart Lung Transplant 1992;11:446–52. - PubMed

MeSH terms