Rhythm recovery in patients with permanent pacemaker after cardiac surgery

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Ribeiro V (Author) Other; Mota Garcia R (Author) Other; Frutuoso C (Author) Other; Melão F (Author) Other; Araújo C (Author) Other; Pinho P (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Heart Journal

Pages: 545-545

ESC Congress 2012

Munich, 25 a 29 de Agosto de 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: Conduction disturbances requiring permanent pacemaker (PM) implantation after cardiac surgery occur in 1-3% of patients. Our aim was to assess the association between the rhythm in the baseline ECG and the long term rhythm recovery probability, among patients submitted to permanent PM implantation after cardiac surgery. Methods: We conducted a cross-sectional study of all consecutive patients submitted to permanent PM after cardiac surgery between January 2004 and December 2010 (seven years). Absence of rhythm recovery (of sinus rhythm or atrial fibrillation with appropriate ventricular frequency) was defined as needing pacemaker in the long-term. Patients who had a formal indication to pacemaker implantation before the surgery and those who had implanted the device 60 days or more after surgery were excluded. The association between baseline variables and long term rhythm recovery was estimated through odds ratio (OR). Logistic regression was used in multivariate analysis. Results: One hundred and fifteen patients (mean age 64,9±12,7 years old) were submitted to permanent PM implantation (10,5±6,0 days after surgery), due to complete atrioventricular block (87,8%), slow atrial fibrillation (8,7%) and other atrioventricular conduction disturbances (3,5%). The baseline ECG (previous to surgery) showed sinus rhythm in 69,6% and atrial fibrillation in 28,7% of the patients. During 995,0±748,8 days of follow-up, 59,1% (77,9% with baseline sinus rhythm and 19,1% with baseline atrial fibrillation) of the patients did not recover the rhythm. The risk of no long term rhythm recovery was almost 7-fold higher in patients with sinus rhythm than in patients with atrial fibrillation (OR 6,94; 95%CI: 1,31-6,98). This risk was also higher for patients submitted to aortic mechanic valve replacement (OR 3,05; 95%CI: 1,1-8,3), in those with previous myocardial infarction (OR 1,21; 95%CI 1,09-1,36) and in those with higher mean surgery duration (321,4±129,7 vs 274,4±88,6; p=0,033). The aetiology of valvular disease was another factor influencing recovery probability (p=0,003). After adjusting, atrial fibrillation was still associated with a higher probability of long-term rhythm recovery (adjusted OR 3,04; 95%CI:1,20-7,77). Conclusion: A great proportion of patients submitted to permanent PM implantation after cardiac surgery recover rhythm during the follow up. Baseline atrial fibrillation predicts an increase in the probability of recovery. This might suggest that patients with atrial fibrillation may benefit from a longer waiting time before permanent PM implantation.

Language: English

Type (Professor's evaluation): Scientific

Notes: Ribeiro V, Mota Garcia R, Frutuoso C, Melão F, Araújo C, Pinho P, Maciel MJ. Rhythm recovery in patients with permanent pacemaker after cardiac surgery. Eur Heart J 2012; 33 (Abstract Suppl): 545