title: Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up.
abstract: BACKGROUND
  Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent.
  
  
  METHODS
  We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 +/- 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients.
  
  
  RESULTS
  Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 +/- 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001).
  
  
  CONCLUSIONS
  Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge.
authors.affiliation: Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
authors.forename: Michael
authors.initials: M
authors.lastname: Ilan
authors.forename: Avraham
authors.initials: A
authors.lastname: Oren
authors.forename: Daniel
authors.initials: D
authors.lastname: Fink
authors.forename: Maher
authors.initials: M
authors.lastname: Deeb
authors.forename: Dani
authors.initials: D
authors.lastname: Bitran
authors.forename: Shuli
authors.initials: S
authors.lastname: Silberman
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome