Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Permanent pacemaker implantation (PPI) is a rare complication following cardiac surgery.
• There is a lack of consensus regarding optimal timing for PPI and limited data on long-term outcomes.
• Understanding pacemaker dependency (PMD) and independence (PMI) is crucial for patient management.

Purpose of the Study:

• To assess pacemaker dependency (PMD) and long-term mortality in patients who underwent PPI after cardiac surgery.
• To evaluate the rate of pacemaker independence (PMI) at follow-up.
• To identify factors associated with PMD and PMI.

Main Methods:

• Multicenter retrospective study involving 859 patients who received PPI between 2004 and 2016.
• Time-to-event data analyzed using Cox regression and Fine and Gray competing risk models.
• Follow-up data collected to assess pacemaker status and survival.

Main Results:

• 30.5% of patients achieved pacemaker independence (PMI) by 6 months post-PPI.
• Pacemaker dependency (PMD) was associated with significantly higher long-term mortality compared to PMI (10-year survival 80.1% vs 92.2%).
• Preoperative sinus rhythm with normal conduction favored PMI, while coronary artery bypass grafting and aortic valve replacement were linked to PMD.

Conclusions:

• Although a substantial proportion of patients achieve pacemaker independence (PMI) after PPI, pacemaker dependency (PMD) portends a worse long-term survival.
• Identifying predictors of PMD and PMI can aid in risk stratification and patient counseling.
• Further research into optimal management strategies for PPI patients is warranted.