Permanent pacemaker implantation following aortic valve replacement: current prevalence and clinical predictors.
BACKGROUND
The incidence of conduction disease requiring permanent pacemaker (PPM) implantation following aortic valve replacement (AVR) ranges from 3% to 6%. Data concerning the potential risks for PPM requirement associated with certain valve types have been conflicting and controversial. We sought to evaluate the prevalence, predictors for PPM implantation, and PPM dependency during follow-up in patients undergoing AVR.


METHODS
A total of 214 consecutive patients undergoing AVR were studied retrospectively. A total of 207 patients were included in the statistical analysis. Clinical variables including valve size and types were catalogued and the incidence of PPM evaluated. Cardiac rhythm device clinic records were examined and PPM dependency status was catalogued. Multivariate analyses were performed to determine predictors of PPM implantation and PPM dependency during follow-up.


RESULTS
Fifteen patients (7.2%) required PPM postoperatively. After controlling for clinical and surgical characteristics, predictors for PPM included preoperative first-degree atrioventricular block with and without left anterior fascicular block or intraventricular conduction delay [odd ratios (OR) = 12.5, P = 0.001], cardiac arrest postoperatively (OR = 9.4, P = 0.012), and combined aortic and mitral valve surgery (OR = 11.5, P = 0.027). Aortic valve types did not predict complete heart block (CHB) and PPM implantation. Of those patients who underwent PPM implantation, 70% were classified as PPM dependent during long-term follow-up.


CONCLUSIONS
CHB and PPM implantation continue to be common complications of AVR. Preexisting atrioventricular with intrafascicular or intraventricular conduction disease along with cardiac arrest and dual valve surgery are the most important significant predictors of PPM implantation and PPM dependency during follow-up. The selection of valve types did not predict conduction disease requiring PPM implantation.
Division of Cardiology, Providence Hospital and Medical Center/Wayne State University School of Medicine, Southfield, Michigan, USA.
Hieu
H
Huynh
Ghassan
G
Dalloul
Hamid
H
Ghanbari
Peter
P
Burke
Mariam
M
David
Marcos
M
Daccarett
Christian
C
Machado
Shukri
S
David
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D054537:Atrioventricular Block / Q000150:complications; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications; D006329:Heart Conduction System / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies