title: Permanent Pacemaker Implantation Early After Cardiac Surgery: A Descriptive Study of Pacemaker Utility After One Year of Follow-Up.
abstract: BACKGROUND
  Complete heart block (CHB) is a common complication of cardiac surgery, which may resolve spontaneously. The optimal number of days to wait for resolution of CHB prior to proceeding with a permanent pacemaker (PPM) and the long-term utility of PPMs placed in this setting remain uncertain.
  
  
  RESULTS
  This was a retrospective cohort study, which included members of Kaiser Permanente Northern California who had cardiac surgery, a PPM placed within 30 days after surgery, and one year of follow-up time. Chart review was performed to determine the frequency of ventricular pacing at each PPM interrogation visit up to one year after surgery. A PPM was categorized as underutilized at the time of an interrogation if none of the following were present: underlying rhythm <40 bpm, persistent CHB, or >1% ventricular pacing. The study included 247 patients with a mean time from cardiac surgery to PPM of 6.5 days. In 33 cases (13%), underutilized status was confirmed. The time from surgery to PPM implant was significantly higher in the underutilized group (8.1 ± 4.2 days vs. 6.2 ± 4.2 days, p = 0.003).
  
  
  CONCLUSIONS
  The majority of PPMs placed early after cardiac surgery are not underutilized. In this retrospective, observational study, longer delay from surgery to PPM implantation was not associated with a greater likelihood that the PPM would be utilized long term. A prospective study is required to determine optimal timing of PPM implantation in this setting.
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Verma
authors.affiliation: Kaiser Northern California Division of Research, Oakland, California.
authors.forename: Sheng-Fang
authors.initials: SF
authors.lastname: Jiang
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Lau
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Arrellano
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Cain
authors.affiliation: Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, California.|Kaiser Northern California Division of Research, Oakland, California.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Zaroff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult