title: Long-term mortality and pacing outcomes of patients with permanent pacemaker implantation after cardiac surgery.
abstract: BACKGROUND
  Approximately 20,000 permanent pacemakers (PPMs) are implanted annually for bradycardia or atrioventricular (AV) block after cardiac surgery. Little is known about the long-term pacing and mortality outcomes and the temporal trends of these patients.
  
  
  METHODS
  We examined 6,268 consecutive patients who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center between 1987 and 2010. Patients who had a PPM within 30 days of cardiac surgery were identified. Pacemaker interrogation records were retrospectively reviewed and mortality was ascertained.
  
  
  RESULTS
  Overall, 141 (2.2%) patients underwent PPM implantation for high-degree AV block (55%) and bradycardia (45%), 9 ± 6 days after surgery. Age, diuretic use, cardiopulmonary bypass time (CPBT), and valve surgery were independent predictors of PPM requirement. After 5.6 ± 4.2 years of follow-up, 40% of the patients were PPM dependent. Longer CPBT (P = 0.03), PR interval >200 ms (P = 0.03), and QRS interval > 120 ms (P = 0.04) on baseline electrocardiogram predicted PPM dependency . In univariable analysis, PPM patients had a higher long-term mortality than those without PPM (45% vs 36%; P = 0.02). However, after adjusting for age, sex, type of surgery, and CPBT, PPM requirement was not associated with long-term mortality (hazard ratio 1.3; 95% confidence interval 0.9-1.9; P = 0.17). Compared to before, incidence of PPM implantation increased after the year 2000 (1.9% vs 2.6%; P = 0.04).
  
  
  CONCLUSIONS
  The majority of patients who require PPM after cardiac surgery are not PPM dependent in the long term. Requiring a PPM after surgery is not associated with long-term mortality after adjustment for patient-related risk factors and cardiac surgical procedure.
authors.affiliation: Divisions of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Raza
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Li
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.forename: Venkatakrishna N
authors.initials: VN
authors.lastname: Tholakanahalli
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Mbai
authors.forename: A Selcuk
authors.initials: AS
authors.lastname: Adabag
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D003131:Combined Modality Therapy; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D019919:Prosthesis Implantation / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology