Permanent Pacemaker Implantation Early After Cardiac Surgery: A Descriptive Study of Pacemaker Utility After One Year
Ajay M Patel1, Dhruv Verma1, Sheng-Fang Jiang2
1Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
Insights
Most permanent pacemakers (PPMs) implanted after cardiac surgery are utilized. Waiting longer to implant a PPM does not increase its long-term use, suggesting current practices are appropriate.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Complete heart block (CHB) is a frequent complication following cardiac surgery.
- Spontaneous resolution of CHB is possible, creating uncertainty regarding optimal timing for permanent pacemaker (PPM) implantation.
- The long-term utility of PPMs in this patient population requires further investigation.
Purpose of the Study:
- To evaluate the utilization of PPMs implanted within 30 days after cardiac surgery.
- To determine if a longer waiting period for PPM implantation is associated with increased long-term device utility.
- To identify factors influencing PPM underutilization in post-cardiac surgery patients.
Main Methods:
- Retrospective cohort study of 247 patients undergoing cardiac surgery and subsequent PPM implantation.
- Chart review to assess ventricular pacing frequency and underlying rhythm at PPM interrogations up to one year post-surgery.
- PPM underutilization defined by absence of bradycardia, persistent CHB, or significant ventricular pacing (>1%).
Main Results:
- The mean time from cardiac surgery to PPM implantation was 6.5 days.
- 13% of patients (33/247) had their PPM categorized as underutilized.
- Patients with underutilized PPMs had a significantly longer delay between surgery and PPM implantation (8.1 days vs. 6.2 days).
Conclusions:
- The majority of early-implanted PPMs after cardiac surgery demonstrate appropriate utilization.
- A longer delay from surgery to PPM implantation was not linked to increased long-term PPM utility.
- Prospective research is necessary to establish the optimal timing for PPM implantation post-cardiac surgery.
Background:
Complete heart block (CHB) is a common complication of cardiac surgery, which may resolve spontaneously. The optimal number of days to wait for resolution of CHB prior to proceeding with a permanent pacemaker (PPM) and the long-term utility of PPMs placed in this setting remain uncertain.
Methods And Results:
This was a retrospective cohort study, which included members of Kaiser Permanente Northern California who had cardiac surgery, a PPM placed within 30 days after surgery, and one year of follow-up time. Chart review was performed to determine the frequency of ventricular pacing at each PPM interrogation visit up to one year after surgery. A PPM was categorized as underutilized at the time of an interrogation if none of the following were present: underlying rhythm <40 bpm, persistent CHB, or >1% ventricular pacing. The study included 247 patients with a mean time from cardiac surgery to PPM of 6.5 days. In 33 cases (13%), underutilized status was confirmed. The time from surgery to PPM implant was significantly higher in the underutilized group (8.1 ± 4.2 days vs. 6.2 ± 4.2 days, p = 0.003).
Conclusions:
The majority of PPMs placed early after cardiac surgery are not underutilized. In this retrospective, observational study, longer delay from surgery to PPM implantation was not associated with a greater likelihood that the PPM would be utilized long term. A prospective study is required to determine optimal timing of PPM implantation in this setting.
