The impact of permanent pacemaker implantation on long-term survival after cardiac surgery: A systematic review and meta-analysis
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Published on: July 18, 2014
Yosuke Sakurai1, J Hunter Mehaffey2, Toshiki Kuno3
1Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WVa.
Objectives:
The long-term impact of permanent pacemaker (PPM) implantation on survival after cardiac surgery remains ill defined. We aimed to investigate the effect of PPM on survival and explore factors driving outcomes using meta-regression according to the type of surgery.
Methods:
MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched through October 2023 to identify studies reporting the long-term outcomes of PPM implantation. The primary outcome was all-cause mortality during follow-up. The secondary outcome was heart failure rehospitalization. The subgroup analysis and meta-regression analysis were performed according to the type of surgery.
Results:
A total of 28 studies met the inclusion criteria. 183,555 patients (n = 6298; PPM, n = 177,257; no PPM) were analyzed for all-cause mortality, with a weighted median follow-up of 79.7 months. PPM implantation was associated with increased risks of all-cause mortality during follow-up (hazard ratio, 1.22; confidence interval, 1.08-1.38, P < .01) and heart failure rehospitalization (hazard ratio, 1.24; confidence interval, 1.01-1.52, P = .04). Meta-regression demonstrated the adverse impact of PPM was less prominent in patients undergoing mitral or tricuspid valve surgery, whereas studies with a greater proportion with aortic valve replacement were associated with worse outcomes. Similarly, a greater proportion with atrioventricular block as an indication of PPM was associated with worse survival.
Conclusions:
PPM implantation after cardiac surgery is associated with a greater risk of long-term all-cause mortality and heart failure rehospitalization. This impact is more prominent in patients undergoing aortic valve surgery or atrioventricular block as an indication than those undergoing mitral or tricuspid valve surgery.
Insights
Permanent pacemaker (PPM) implantation after heart surgery increases long-term mortality and heart failure risk. The negative impact is less pronounced after mitral/tricuspid valve surgery compared to aortic valve surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- The long-term survival implications of permanent pacemaker (PPM) implantation following cardiac surgery are not well understood.
- Understanding these outcomes is crucial for optimizing patient management post-surgery.
Purpose of the Study:
- To investigate the long-term impact of PPM implantation on survival after cardiac surgery.
- To explore factors influencing outcomes, particularly the type of cardiac surgery performed, using meta-regression.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and the Cochrane Library up to October 2023.
- Meta-regression and subgroup analyses were performed on data from 28 studies involving 183,555 patients.
- Primary outcome was all-cause mortality; secondary outcome was heart failure rehospitalization.
Main Results:
- PPM implantation was associated with a significant increase in all-cause mortality (HR 1.22) and heart failure rehospitalization (HR 1.24).
- Meta-regression revealed that the adverse effect of PPM was less pronounced in patients undergoing mitral or tricuspid valve surgery.
- Conversely, studies with a higher proportion of aortic valve replacement and atrioventricular block as an indication for PPM showed worse outcomes.
Conclusions:
- Permanent pacemaker implantation after cardiac surgery is linked to increased long-term all-cause mortality and heart failure rehospitalization.
- The detrimental effect of PPM is more significant in patients undergoing aortic valve surgery or those with atrioventricular block compared to mitral or tricuspid valve surgery.
