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Immediate and long-term need for permanent cardiac pacing following aortic valve replacement.

  • Viktorsson, Sindri A1
  • Orrason, Andri W1
  • Vidisson, Kristjan O1
  • Gunnarsdottir, Anna G1
  • Johnsen, Arni1
  • Helgason, Dadi2
  • Arnar, David O3
  • Geirsson, Arnar4
  • Gudbjartsson, Tomas1, 5
  • 1 Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland. , (Iceland)
  • 2 Internal Medicine Services, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland. , (Iceland)
  • 3 Division of Cardiology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland. , (Iceland)
  • 4 Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA.
  • 5 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. , (Iceland)
Published Article
Scandinavian cardiovascular journal : SCJ
Publication Date
Dec 06, 2019
DOI: 10.1080/14017431.2019.1698761
PMID: 31809597


Introduction: Atrioventricular (AV) node conduction disturbances are common following surgical aortic valve replacement (SAVR), and in some cases the patient needs a permanent pacemaker (PPM) implantation before discharge from hospital. Little is known about the long-term need for PPM and the PPM dependency of these individuals. We determined the incidence of PPM implantation before and after discharge in SAVR patients. Methods: We studied 557 consecutive patients who underwent SAVR for aortic stenosis in Iceland between 2002 and 2016. Timing and indication for PPM were registered, with a new concept, ventricular pacing proportion (VPP), defined as ventricular pacing ≥90% of the time, being used to approximate pacemaker dependency. The median follow-up time was 73 months. We plotted the cumulative incidence of pacemaker implantation, treating death as a competing risk. Results: Of the 557 patients, 22 (3.9%) received PPM in the first 30 days after surgery, most commonly for complete AV block (n = 14) or symptomatic bradycardia (n = 8); Thirty-eight other patients (6.8%) had a PPM implanted >30 days postoperatively, at a median of 43 months after surgery (range 0‒181), most often for AV block (n = 13) or sick-sinus syndrome (n = 10). The cumulative incidence of PPM implantation at 1, 5, and 10 years postoperatively was 5.0%, 9.2%, and 12.3%, respectively. During follow-up, 45.0% of the 60 patients had VPP ≥90%. Conclusion: The cumulative incidence of permanent pacemaker implantation following SAVR was about 12% at 10 years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.

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