title: Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time?
abstract: OBJECTIVE
  Permanent pacemaker (PPM) implantation is required in 3-8% of all patients undergoing aortic valve replacement (AVR). Our aim was to evaluate long-term PPM dependency and recovery of atrioventricular (AV) conduction disorders during follow-up in these patients.
  
  
  METHODS
  Since January 1997, a total of 2106 consecutive patients underwent isolated AVR at our institution. Of these, 138 patients (6.6%, 72 female, median age 71 (37-89) years) developed significant conduction disorders leading to PPM implantation postoperatively. Preoperative ECG showed normal sinus rhythm (n = 64), first degree AV block (n = 19), left bundle branch block (n = 13), right bundle branch block (n = 16), left anterior hemiblock (n = 14) and AV block with ventricular escape rhythm (n = 10). Atrial fibrillation was present in 23 patients. Pacemakers were implanted after a median of 7 (1-30) days following AVR. PPM dependency was analysed by ECG and pacemaker check during follow-up.
  
  
  RESULTS
  A total of 45 of 138 patients with postoperative PPM Implantation died during a mean follow-up time of 5.3 ± 4.7 years. A further 9 patients were lost to follow-up. Long-term survivals at 1, 5 and 10 years were 88%, 79% and 59%, respectively. Only 8 (10%) of 84 survivors were no longer pacemaker-dependent. The majority of patients (n = 66, 79%) required permanent ventricular stimulation, and the remaining 10 (13%) showed intermittent stimulation with a mean ventricular stimulation fraction of 73% (22-98%).
  
  
  CONCLUSIONS
  The majority of patients do not recover from AV conduction disorders after AVR. Since higher-grade AV blocks expose patients to a high risk of sudden death after surgery, we recommend early implantation of permanent pacemaker.
authors.affiliation: Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. baraki.hassina@mh-hannover.de
authors.forename: Hassina
authors.initials: H
authors.lastname: Baraki
authors.forename: Ammar
authors.initials: A
authors.lastname: Al Ahmad
authors.forename: Stefan
authors.initials: S
authors.lastname: Jeng-Singh
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Jan Dieter
authors.initials: JD
authors.lastname: Schmitto
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fleischer
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Ingo
authors.initials: I
authors.lastname: Kutschka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006329:Heart Conduction System / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome