[Permanent pacemaker implantation after heart surgery: incidence and indications].
BACKGROUND
New conduction disturbances requiring pacemaker implantation occur in about 1-3% of patients undergoing heart surgery. We reviewed our experience with patients undergoing heart surgery between the years 1993-2005 in order to identify predictors for pacemaker requirement.


METHODS
There were 4999 patients aged 64 +/- 12 years. Coronary bypass was performed in 3448 (69%), valve surgery in 831 (17%), combined procedures in 623 (12%), and other procedures in 97 (2%).


RESULTS
Overall, 72 (1.4%) patients required pacemaker implantation for the following indications: complete atrioventricular block (AVB) in 59, second degree AVB in 2, severe bradycardia (< 40 beats/min) in 9, first degree AVB with left bundle branch block (LBBB) in 1, and bifascicular block in 1. For patients undergoing aortic valve replacement, the incidence of pacemaker implantation was 5%. Multivariate analysis identified the following predictors for pacemaker implantation: LBBB, aortic valve replacement, and elevated CPK-MB levels after surgery.


CONCLUSIONS
Patients undergoing heart surgery will require a permanent pacemaker in about 1.4% of cases. Based upon the recognition of predictors for pacemaker requirement, we recommend early implantation in order to enable early mobilization and shorter hospital stay.
Merin
Ofer
O
Shaare Zedek Medical Center, Jerusalem, Israel. merin@szmc.org.il
Silberman
Shuli
S
Ilan
Michael
M
Oren
Avraham
A
Fink
Daniel
D
Bitran
Dani
D
D000368:Aged; D001021:Aortic Valve; D054537:Atrioventricular Block / Q000601:surgery*; D001919:Bradycardia / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*