title: Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era.
abstract: BACKGROUND
  Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era.
  
  
  METHODS
  After exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed.
  
  
  RESULTS
  Patients' mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up.
  
  
  CONCLUSIONS
  Patients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long-term follow-up. We recommend preoperative assessment for risk of requiring postoperative PPM, to counsel patients about this risk and early PPM implantation in high-risk patients who are PPM dependent after surgery.
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Bandar
authors.initials: B
authors.lastname: Al-Ghamdi
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Mallawi
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Azam
authors.initials: A
authors.lastname: Shafquat
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ledesma
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Nadiah
authors.initials: N
authors.lastname: AlRuwaili
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; National Biotechnology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shoukri
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.affiliation: Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Aly
authors.initials: A
authors.lastname: Al Sanei
keywords: Cardiac surgery; Conduction system; Pacemaker