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Atrioventricular Block after Tricuspid Valve Surgery.
Florian Ernst Martin Herrmann1, Helen Graf1, Petra Wellmann1
1Department of Cardiac Surgery, Ludwig Maximilian University.
International Heart Journal
|January 18, 2021
Summary
Post-tricuspid valve surgery, atrioventricular block (AVB) requiring pacemakers occurs in 5.8% of survivors. AVB III at ICU admission and TV endocarditis predict pacemaker need, with high ventricular pacing burden observed.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Tricuspid valve (TV) surgery carries a significant risk of postoperative pacemaker dependency due to atrioventricular block (AVB).
- Understanding the incidence and predictors of AVB is crucial for patient management after TV procedures.
Purpose of the Study:
- To determine the incidence of AVB following tricuspid valve surgery.
- To identify predictors of AVB and subsequent pacemaker requirement.
- To assess the recovery of atrioventricular conduction over time.
Main Methods:
- Retrospective analysis of patients undergoing tricuspid valve surgery (2004-2017).
- Exclusion of patients with pre-existing pacemakers.
- Investigation of pre-, intra-, and postoperative factors associated with AVB and pacemaker implantation.
Main Results:
- 5.8% of surviving patients required pacemaker implantation for AVB within one year post-surgery.
- Atrioventricular block III (AVB III) upon intensive care unit (ICU) admission predicted pacemaker implantation (OR: 9.7).
- Tricuspid valve endocarditis was also a significant predictor (OR: 12.4), with 34% of these patients requiring a pacemaker.
Conclusions:
- Atrioventricular block after tricuspid valve surgery is a notable complication requiring careful monitoring.
- Initial postoperative rhythm and the etiology of tricuspid disease are key factors in predicting pacemaker needs.
- Ventricular pacing burden remains high in the first five years post-pacemaker implantation, indicating limited rhythm recovery.
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