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. 2023 Sep 9:16:276-289.
doi: 10.1016/j.xjon.2023.08.017. eCollection 2023 Dec.

Pacemaker implantation following tricuspid valve annuloplasty

Sigurdur Ragnarsson  1   2   3 , Amar Taha  4   5 , Susanne J Nielsen  5   6 , Andrea Amabile  1 , Arnar Geirsson  1 , Markus Krane  1   7 , David Mörtsell  2   8 , Johan Sjögren  2   3 , Anders Jeppsson  5   6 , Andreas Martinsson  4   5
Affiliations

Pacemaker implantation following tricuspid valve annuloplasty

Sigurdur Ragnarsson et al. JTCVS Open. .

Abstract

Objective: Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases.

Methods: By using data from multiple Swedish mandatory national registries, all patients (n = 1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30 days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression.

Results: The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8 ± 10.3 years vs 67.5 ± 12.4 years, P = .012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03).

Conclusions: This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30 days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.

Keywords: pacemaker implantation; tricuspid annuloplasty; tricuspid valve repair.

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Conflict of interest statement

A.T.: receives consulting fees for being a member of the Medtronic European Advisory Board. A.A.: receives consulting fees from JOMDD. A.G.: receives consulting fees for being a member of the Medtronic Strategic Surgical Advisory Board and from Edwards Lifesciences. M.K.: a physician proctor and a member of the medical advisory board for JOMDD, a physician proctor for Peter Duschek, a medical consultant for EVOTEC and Moderna, and has received speakers’ honoraria from Medtronic and Terumo. D.M.: works as a proctor and has received lecturing honoraria from Medtronic, Abbott and Boston Scientific and is a member of advisory boards for Medtronic and Abbott for pacemaker and implantable cardioverter defibrillator development, unrelated to the present study. A.J.: received consulting fees from AstraZeneca, Werfen, and LFB Biotechnologies unrelated to the present study. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Graphical abstract
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Pacemaker implantation after TA in Sweden 2006 to 2020.
Figure 1
Figure 1
Study flow chart. ICD, Implantable cardioverter defibrillator.
Figure 2
Figure 2
Kaplan–Meier curve showing the estimated rate of PPM implantation in the first 30 days after tricuspid valve repair (blue line, percentage; shaded area, 95% CI).
Figure 3
Figure 3
Cumulative incidence function curve showing the estimated long-term rate of PPM implantation after tricuspid valve repair (blue line, percentage; shaded area, 95% CI).
Figure 4
Figure 4
Kaplan–Meier curves showing the cumulative survival in patients who underwent tricuspid valve repair comparing those who got a PPM within 30 days (red line, percentage; shaded area, 95% CI) with those who did not get a PPM within 30 days after surgery (blue line, percentage; shaded area, 95% CI).
Figure 5
Figure 5
Forest plot showing the aHRs of MACE, heart failure, and death from PPM implantation after tricuspid valve repair. Adjusted for age, sex, aortic surgery, coronary surgery, mitral surgery, myocardial infarction, arrhythmia surgery, heart failure, low ejection fraction (<50%), atrial fibrillation, and diabetes mellitus. aHR, Adjusted hazard ratio; MACE, major adverse cardiovascular events.
Figure 6
Figure 6
Pacemaker implantation following tricuspid annuloplasty: Graphical abstract. OR, Odds ratio; aHR, adjusted hazard ratio; MACE, major adverse cardiovascular events; LVEF, left ventricular ejection fraction.
Figure E1
Figure E1
Kaplan–Meier curve showing the long-term cumulative rate of PPM implantation (blue line, percentage; shaded area, 95% CI).
Figure E2
Figure E2
Incidence of pacemaker implantation within 30 days after surgery, by year of surgery (blue line, percentage; shaded area, 95% CI).
Figure E3
Figure E3
Kaplan–Meier curve showing the estimated rate of PPM implantation in the first 30 days after tricuspid valve repair in patients who had TA with an annuloplasty ring compared with those who had TA with a suture (De Vega annuloplasty). Blue line, percentage; shaded area, 95% CI.
Figure E4
Figure E4
Kaplan–Meier curve showing the long-term survival in patients who received a PPM within 1 year from surgery compared with those who did not receive a pacemaker within the first year from surgery (red line, percentage; shaded area, 95% CI).
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See this image and copyright information in PMC

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