4.6 Article

Post-operative cardiac implantable electronic devices in patients undergoing cardiac surgery: a contemporary experience

Journal

EUROPACE
Volume 23, Issue 1, Pages 104-112

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/europace/euaa241

Keywords

Cardiac surgery; Pacemaker implantation; Atrioventricular block

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The study aimed to determine rates of cardiac implantable electronic devices (CIEDs) implants post-surgery at a high-volume tertiary centre over 3 years, finding that multi-valve surgery has a particularly high incidence of CIED implants. Patient age, left ventricle systolic impairment, infective endocarditis, and valve surgery were independent predictors of CIED implants.
Aims Optimum timing of pacemaker implantation following cardiac surgery is a clinical challenge. European and American guidelines recommend observation, to assess recovery of atrioventricutar block (AVB) (up to 7 days) and sinus node (5 days to weeks) after cardiac surgery. This study aims to determine rates of cardiac implantable electronic devices (CIEDs) implants post-surgery at a high-volume tertiary centre over 3 years. Implant timing, patient characteristics and outcomes at 6 months including pacemaker utilization were assessed. Methods and results All cardiac operations (n = 5950) were screened for CIED implantation following surgery, during the same admission, from 2015 to 2018. Data collection included patient, operative, and device characteristics; pacing utilization and complications at 6 months. A total of 250 (4.2%) implants occurred; 232 (3.9%) for bradycardia. Advanced age, infective endocarditis, left ventricle systolic impairment, and valve surgery were independent predictors for CIED implants (P <0.0001). Relative risk (RR) of CIED implants and proportion of AVB increased with valve numbers operated (single-triple) vs. non-valve surgery: RR 5.4 (95% CI 3.9-7.6)-21.0 (11.4-38.9) CIEDs. Follow-up pacing utilization data were available in 91%. Significant utilization occurred in 82% and underutilization (<1% A and V paced) in 18%. There were no significant differences comparing utilization rates in early (<= day 5 post-operatively) vs. late implants (P= 0.55). Conclusions Multi-valve surgery has a particularly high incidence of CIED implants (14.9% double, 25.6% triple valve). Age, left ventricle systolic impairment, endocarditis, and valve surgery were independent predictors of CIED implants. Device underutilization was infrequent and uninfluenced by implant timing. Early implantation (<= 5 days) should be considered in AVB post-multi-valve surgery.

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