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Permanent cardiac pacing after cardiac operations
1Division of Cardiovascular Surgery, Osaka National Hospital, Japan.
Insights
Permanent pacemaker implantation after heart surgery is crucial for patients with atrioventricular block or sick sinus syndrome. Those with atrioventricular block showed lower survival rates, necessitating regular outpatient follow-up.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Permanent pacemaker implantation is a common procedure following open heart surgery.
- Indications for permanent pacing include atrioventricular block and sick sinus syndrome.
- Tricuspid valve surgery and Adams-Stokes syncopal attacks are significant factors in pacing decisions.
Purpose of the Study:
- To evaluate the outcomes of permanent pacemaker implantation in patients after open heart surgery.
- To compare the survival rates and complications between patients with surgical atrioventricular block and sick sinus syndrome.
Main Methods:
- A retrospective study of 34 patients who underwent permanent pacemaker implantation between January 1980 and December 1990.
- Patients were divided into two groups: Group 1 (surgical atrioventricular block) and Group 2 (sick sinus syndrome).
- Data collected included surgical history, indications for pacing, operative and late mortality, and actuarial survival rates.
Main Results:
- Operative mortality was 22% in Group 1 versus 0% in Group 2 (p < 0.005), primarily due to congestive heart failure.
- Late mortality was 25% in Group 1 and 16% in Group 2.
- Ten-year actuarial survival was significantly lower in Group 1 (70.2%) compared to Group 2 (85.4%) (p < 0.01).
Conclusions:
- Permanent pacemaker implantation outcomes differ significantly between patients with atrioventricular block and sick sinus syndrome post-cardiac surgery.
- Patients with surgical atrioventricular block exhibit poorer long-term survival.
- Regular outpatient monitoring is recommended for asymptomatic patients with atrioventricular block, even without signs of pacemaker failure.
Abstract:
From January 1980 through December 1990, implantation of a permanent pacemaker was performed in 34 patients following open heart surgery. The patients were divided into two groups according to the clinical indications for implantation of permanent pacemakers. Group 1 (9 patients) had surgical atrioventricular block, and Group 2 (25 patients) had sick sinus syndrome. Tricuspid valve surgery was involved in 67% of Group 1 and 64% of Group 2. Adams-Stokes syncopal attack was the prime indication for permanent pacing in 100% of Group 1 and in 72% of Group 2. There were 2 operative deaths in Group 1, and no deaths in Group 2 (22% in Group 1 vs. 0% in Group 2, p < 0.005). Causes of the deaths were not related to the pacemaker implantation but to congestive heart failure following surgery. Among 32 survivors, there were 2 late deaths in Group 1, and 4 deaths in Group 2 (25% in Group 1 vs. 16% in Group 2, p < 0.05). The overall actuarial survival rate at 10 years was 82.1 +/- 2.8%. However, the actuarial survival rate of patients in Group 1 is 70.2 +/- 4.1%, which is statistically less than 85.4 +/- 2.2% in Group 2 (p < 0.01). As judged by these results, patients in Group 1 should be followed on a regular out-patient basis even if they are asymptomatic and there is no evidence of pacemaker failure.