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Updated: Dec 14, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience
Mohammad A Ebrahim1, Hasan Kh Ashkanani2, Reem S Alramzi2
1Department of Pediatrics, Faculty of Medicine, affiliated with Chest Diseases Hospital, Kuwait University, Block 4, Street 102, Postal Office 46300, Jabriya, Kuwait. mohdi84@gmail.com.
Insights
Pacemaker implantation for postoperative atrioventricular block occurred in 1.8% of patients. Higher risks included trisomy 21 and prolonged bypass times, leading to morbidity but no mortality.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrioventricular block is a known complication following congenital heart surgery.
- Previous studies indicate an incidence rate of 1.8% for pacemaker implantation due to this complication.
- Prolonged cardiopulmonary bypass and aortic cross-clamp times are associated with increased risk.
Purpose of the Study:
- To retrospectively analyze the incidence, risk factors, and outcomes of pacemaker implantation secondary to postoperative atrioventricular block in pediatric cardiac surgery patients.
- To identify specific surgical procedures and patient demographics associated with a higher need for pacemakers.
Main Methods:
- Retrospective review of 26 patients who underwent pacemaker implantation between 2011 and 2020.
- Analysis of patient demographics, surgical procedures, cardiopulmonary bypass times, aortic clamp times, and postoperative outcomes.
- Comparison of risk factors between patients requiring and not requiring pacemaker implantation.
Main Results:
- The overall incidence of pacemaker implantation was 1.8%.
- Patients undergoing left ventricular outflow tract repair had the highest incidence (8.6%).
- Trisomy 21 (Down syndrome) patients were four times more likely to require pacemaker implantation (95% CI 1.8-9).
- Longer cardiopulmonary bypass and aortic clamp times were significantly associated with pacemaker implantation (P≤0.05).
- Higher Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgeons scores were observed in patients with pacemakers.
- Pacing-induced dilated cardiomyopathy occurred in 3 patients, and 31% required pacing reintervention.
- Significant morbidity was associated with pacemaker implantation, but no mortality was observed.
Conclusions:
- Pacemaker implantation following congenital heart surgery is associated with significant morbidity but not mortality.
- Key risk factors for pacemaker implantation include left ventricular outflow tract repair, trisomy 21, and prolonged surgical times.
- Early identification of high-risk patients can potentially mitigate complications associated with postoperative atrioventricular block.
Abstract:
This was a retrospective study documenting all pacemaker implantations (PMIs) secondary to postoperative atrioventricular block. A total of 26 patients were included between 2011 and 2020. The incidence rate was 1.8%, with a median follow-up time of 4.5 years. At the time of the initial PMI, the median weight was 5 kg, and the median generator longevity was 45 months. Mean cardiopulmonary bypass and aortic clamp times were significantly longer among surgeries complicated with PMI (P≤ 0.05). Trisomy 21 patients were 4 times more likely to need a PMI (95% CI 1.8-9, P < 0.001). The mean Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgery scores were higher in patients with PMI. All initial PMIs were epicardial (18 single chamber). Most patients underwent ventricular septal defect closure (isolated or complex), except for 5 patients who underwent left-sided surgery. Pacing-induced dilated cardiomyopathy occurred in 3 patients. All implanted leads were functional except for 2 leads with high thresholds and another biventricular system infection. There was a 31% rate of pacing reintervention.Conclusion: PMI resulted in significant morbidity but without mortality. The highest risk for PMI was left ventricular outflow tract repair, trisomy 21, prolonged cardiopulmonary bypass, and aortic cross times. What is Known: •Incidence rate for postoperative atrioventricular block requiring pacemaker was at 1.8%, similar to previously published reports. •Longer cardiopulmonary bypass and aortic cross-clamp times were associated with higher risk for developing postoperative persistent atrioventricular block. What is New: •Incidence for persistent atrioventricular block requiring pacemaker was highest among left ventricular outflow tract surgery at 8.6%. •Following all intracardiac repair, Down syndrome patients were 4 times more likely to need a pacemaker implantation compared to the non-syndromic group.
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