[Permanent pacemaker implantation after heart surgery: incidence and indications]

New conduction disturbances requiring pacemaker implantation occur in about 1-3% of patients undergoing heart surgery. We reviewed our experience with patients undergoing heart surgery between the years 1993-2005 in order to identify predictors for pacemaker requirement.

There were 4999 patients aged 64 +/- 12 years. Coronary bypass was performed in 3448 (69%), valve surgery in 831 (17%), combined procedures in 623 (12%), and other procedures in 97 (2%).

Overall, 72 (1.4%) patients required pacemaker implantation for the following indications: complete atrioventricular block (AVB) in 59, second degree AVB in 2, severe bradycardia (< 40 beats/min) in 9, first degree AVB with left bundle branch block (LBBB) in 1, and bifascicular block in 1. For patients undergoing aortic valve replacement, the incidence of pacemaker implantation was 5%. Multivariate analysis identified the following predictors for pacemaker implantation: LBBB, aortic valve replacement, and elevated CPK-MB levels after surgery.

Patients undergoing heart surgery will require a permanent pacemaker in about 1.4% of cases. Based upon the recognition of predictors for pacemaker requirement, we recommend early implantation in order to enable early mobilization and shorter hospital stay.