title: Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis.
abstract: OBJECTIVE
  To assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.
  
  
  METHODS
  A total of 780 consecutive elderly patients (age 77 ± 4 years, logistic EuroSCORE 10.4 ± 8.5%, STS score 3.5 ± 1.5%) with severe aortic stenosis and no previous pacemaker were analysed.
  
  
  METHODS
  The incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.
  
  
  RESULTS
  Baseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p = 0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p = 0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p = 0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p = 0.12).
  
  
  CONCLUSIONS
  The need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Juan Maria
authors.initials: JM
authors.lastname: Manazzoni
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Jean
authors.initials: J
authors.lastname: Perron
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Éric
authors.initials: É
authors.lastname: Charbonneau
authors.forename: Jacques
authors.initials: J
authors.lastname: Metrás
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome