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. 2021 Jan 27;23(1):104-112.
doi: 10.1093/europace/euaa241.

Post-operative cardiac implantable electronic devices in patients undergoing cardiac surgery: a contemporary experience

Peter Henry Waddingham  1   2 , Jonathan M Behar  1 , Neil Roberts  1 , Gurpreet Dhillon  1   2 , Adam J Graham  1   2   3 , Ross J Hunter  1   2 , Carl Hayward  1 , Mehul Dhinoja  1 , Amal Muthumala  1 , Rakesh Uppal  1 , Edward Rowland  1 , Mark J Earley  1 , Richard J Schilling  1   2 , Simon Sporton  1 , Martin Lowe  1 , Amer Harky  1 , Oliver R Segal  1 , Pier D Lambiase  1   2   3 , Anthony W C Chow  1   2
Affiliations

Post-operative cardiac implantable electronic devices in patients undergoing cardiac surgery: a contemporary experience

Peter Henry Waddingham et al. Europace. .

Abstract

Aims: Optimum timing of pacemaker implantation following cardiac surgery is a clinical challenge. European and American guidelines recommend observation, to assess recovery of atrioventricular block (AVB) (up to 7 days) and sinus node (5 days to weeks) after cardiac surgery. This study aims to determine rates of cardiac implantable electronic devices (CIEDs) implants post-surgery at a high-volume tertiary centre over 3 years. Implant timing, patient characteristics and outcomes at 6 months including pacemaker utilization were assessed.

Methods and results: All cardiac operations (n = 5950) were screened for CIED implantation following surgery, during the same admission, from 2015 to 2018. Data collection included patient, operative, and device characteristics; pacing utilization and complications at 6 months. A total of 250 (4.2%) implants occurred; 232 (3.9%) for bradycardia. Advanced age, infective endocarditis, left ventricle systolic impairment, and valve surgery were independent predictors for CIED implants (P < 0.0001). Relative risk (RR) of CIED implants and proportion of AVB increased with valve numbers operated (single-triple) vs. non-valve surgery: RR 5.4 (95% CI 3.9-7.6)-21.0 (11.4-38.9) CIEDs. Follow-up pacing utilization data were available in 91%. Significant utilization occurred in 82% and underutilization (<1% A and V paced) in 18%. There were no significant differences comparing utilization rates in early (≤day 5 post-operatively) vs. late implants (P = 0.55).

Conclusion: Multi-valve surgery has a particularly high incidence of CIED implants (14.9% double, 25.6% triple valve). Age, left ventricle systolic impairment, endocarditis, and valve surgery were independent predictors of CIED implants. Device underutilization was infrequent and uninfluenced by implant timing. Early implantation (≤5 days) should be considered in AVB post-multi-valve surgery.

Keywords: Atrioventricular block; Cardiac surgery; Pacemaker implantation.

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