title: Incidence, indications, risk factors, and survival of patients undergoing cardiac implantable electronic device implantation after open heart surgery.
abstract: OBJECTIVE
  The incidence, indications, and risk factors for cardiac implantable electronic device (CIED) implantation after cardiac surgery in an era with an aging population are not well described. There are limited data about the survival of these patients compared with a non-device group. We aimed to evaluate the incidence, indications, and risk factors for postoperative CIED implantation. We also assessed survival of these patients compared with a non-device group.
  
  
  METHODS
  We included all patients without prior CIED implantation who underwent cardiac surgery at our institution from 1996 to 2008. Characteristics associated with CIED implantation were identified by multivariable logistic regression. A propensity model was constructed to compare survival.
  
  
  RESULTS
  A total of 39 546 patients were included in the study of which 1608 patients (4.1%) underwent postoperative CIED implantation. Conduction disease accounted for most devices, but 371 patients underwent CIED implantation for secondary prevention of ventricular arrhythmias. Risk factors associated with implantation included older age, valvular disease, atrial fibrillation, and prior surgery. The propensity-adjusted risk of early death (within 1 year) was significantly less in the device group (hazard ratio [HR] 0.38; 95% confidence interval [CI] 0.22-0.65; P = 0.0004). However, the propensity-adjusted risk of late death was significantly greater in the device group (HR 1.3; 95% CI 1.2-1.5; P = <0.0001).
  
  
  CONCLUSIONS
  Despite an aging population, the incidence of CIED implantation after cardiac surgery remains low and varies by the type of operation. Follow-up suggests increased early survival but decreased late survival in patients who undergo CIED implantation compared with a non-device group.
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Newton B
authors.initials: NB
authors.lastname: Wiggins
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chong
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
authors.forename: Khaldoun G
authors.initials: KG
authors.lastname: Tarakji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D010138:Pacemaker, Artificial; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*
keywords: Cardiac surgery; Implantable cardioverter-defibrillator; Implantation rate; Mortality; Patient characteristics; Permanent pacemaker