Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.
Publication/Presentation Date
5-21-2019
Abstract
BACKGROUND: The incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone.
OBJECTIVES: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS.
METHODS: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality.
RESULTS: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class.
CONCLUSIONS: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370).
Volume
73
Issue
19
First Page
2427
Last Page
2435
ISSN
1558-3597
Published In/Presented At
DeRose, J. J., Jr, Mancini, D. M., Chang, H. L., Argenziano, M., Dagenais, F., Ailawadi, G., Perrault, L. P., Parides, M. K., Taddei-Peters, W. C., Mack, M. J., Glower, D. D., Yerokun, B. A., Atluri, P., Mullen, J. C., Puskas, J. D., O'Sullivan, K., Sledz, N. M., Tremblay, H., Moquete, E., Ferket, B. S., … CTSN Investigators (2019). Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation. Journal of the American College of Cardiology, 73(19), 2427–2435. https://doi.org/10.1016/j.jacc.2019.02.062
Disciplines
Medicine and Health Sciences
PubMedID
31097163
Department(s)
Department of Surgery
Document Type
Article