Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up

Abstract

The aim of the present study was to investigate potential preoperative, operative, and postoperative predictors of pacemaker (PM) dependency after coronary, mitral valve, and aortic valve surgery. One hundred two patients (mean age 68 +/- 11 years; 62% men) who had received a permanent PM after cardiac surgery were included. The presence of any pacing activity in VVI mode with a lower rate of 30 beats/min was defined as PM dependency. Median time to PM implantation was 10 days after the index surgery. Pacemaker indications were atrioventricular block (AVB), sinus node dysfunction, and slow atrial fibrillation in 70%, 20%, and 11% of patients, respectively. At baseline, PM dependency rates were 0%, 9%, and 15% for patients with sinus node dysfunction, slow atrial fibrillation, and AVB, respectively (p = 0.158). Corresponding values at last follow-up were 15%, 9%, and 41% (p = 0.02). During long-term follow-up, new PM dependency developed in 21 patients (23%). Most patients had AVB as the PM indication (18 of 21 patients; 86%). Cumulative probabilities of freedom from PM dependency in patients with AVB were 63% and 30% at 5 and 10 years, respectively. Of several demographic, preoperative clinical, electrocardiographic, operative, and postoperative characteristics of patients, preoperative history of syncope (odds ratio [OR] 6.58, 95% confidence interval [CI] 1.11 to 38.87), body mass index >or=28.5 kg/m2 (OR 2.88, 95% CI 1.08 to 7.67), bypass time >or=105 minutes (OR 4.81, 95% CI 1.54 to 15.02), and AVB as PM indication (OR 5.14, 95% CI 1.51 to 17.44) were independent predictors of long-term PM dependency in multivariate logistic regression analysis. In conclusion, the long-term PM dependency rate was relatively high in patients with postoperative AVB requiring permanent PM implantation. A preoperative history of syncope, body mass index >or=28.5 kg/m2, bypass time of 105 minutes, and AVB as PM indication were independent predictors of long-term PM dependency after cardiac surgery.