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Pacemaker Implantation After Valve Surgery
Study Questions:
What is the prevalence of pacemaker implantation after open aortic valve replacement (AVR), mitral valve replacement (MVR), or mitral valve repair (MVr)?
Methods:
A mandatory New York state hospital discharge database was used to identify consecutive patients who underwent AVR (n = 49,706), MVR (n = 14,686), MVr (n = 8,219), AVR plus MVR (n = 4,202), or AVR plus MVr (n = 1,069) in 1996-2014. The primary endpoint was pacemaker implantation within 1 year of surgery.
Results:
The prevalence of pacemaker implantation was lowest after MVr (4.5%) and highest after AVR plus MVR (13.3%). The prevalence was 6.6% after AVR by itself, 9.3% after AVR plus MVr, and 10.5% after MVR. Most pacemaker implantations (80%) were performed during the index hospitalization. Risk factors for early pacemaker implantation were age, history of arrhythmias, pre-existing conduction defects, and concomitant bypass graft surgery or surgical ablation. Risk factors for late pacemaker implantation included age, diabetes, and chronic lung disease.
Conclusions:
High-degree atrioventricular block requiring pacemaker implantation remains fairly common after aortic and mitral valve surgery, occurring most often after double-valve replacement (13.3%) and least commonly after MVr (4.5%).
Perspective:
This very large study demonstrates that the need for pacemaker implantation after valve surgery depends on the type of procedure being performed and on risk factors such as age and a baseline conduction defect, for example, bundle branch block. Of note is that contemporary experience has indicated that the prevalence of pacemaker implantation after transcatheter AVR is similar to the prevalence after surgical AVR (5.5% and 6.6%, respectively). Because of close proximity of the conduction system to the aortic and mitral valves, it seems unlikely that significant reductions in the need for pacemaker implantation after valve interventions will occur in the future.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Ablation Techniques, Aortic Valve, Arrhythmias, Cardiac, Atrioventricular Block, Bundle-Branch Block, Cardiac Surgical Procedures, Diabetes Mellitus, Heart Valve Diseases, Heart Valve Prosthesis, Lung Diseases, Mitral Valve, Pacemaker, Artificial, Risk Factors, Secondary Prevention, Transcatheter Aortic Valve Replacement
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