Sinus node dysfunction and related permanent pacemaker implantation after major cardiac surgeries, systematic review,...

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Clinical guidelines for sinus node dysfunction (SND) and permanent pacemaker (PPM) implantation post-cardiac surgery are lacking.
• Evidence on the incidence and management of SND following cardiac procedures is limited.

Purpose of the Study:

• To systematically review the current evidence on the prevalence of SND after cardiac surgery.
• To determine the incidence of PPM implantation related to SND.
• To identify risk factors for SND and PPM implantation in this patient population.

Main Methods:

• A systematic search of four major databases (Cochrane Library, Medline, SCOPUS, Web of Science) was conducted.
• Data from 87 studies involving 38,519 patients were analyzed using a proportion meta-analysis.
• Subgroup analyses and meta-regression were employed to evaluate intervention effects and covariates.

Main Results:

• The overall prevalence of PPM implantation due to SND post-cardiac surgery was 2.87%.
• Maze surgery demonstrated the highest prevalence of PPM implantation (4.93%), while lone valve surgery had the lowest.
• The pooled prevalence of SND was 13.71%; no significant association was found with age, gender, or procedural times.

Conclusions:

• Patients undergoing maze and valve-maze procedures face a higher risk of post-operative SND.
• Lone valve surgery is associated with the lowest prevalence of PPM implantation.
• Further research is needed to establish clear management guidelines for SND post-cardiac surgery.