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

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Authors
Viktorsson, Sindri A
Orrason, Andri W
Vidisson, Kristjan O
Gunnarsdottir, Anna G
Johnsen, Arni
Helgason, Dadi
Arnar, David O
Geirsson, Arnar
Gudbjartsson, Tomas
Issue Date
2019-12-06

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Citation
Viktorsson SA, Orrason AW, Vidisson KO, Gunnarsdottir AG, Johnsen A, Helgason D, et al. Immediate and long-term need for permanent cardiac pacing following aortic valve replacement. Scand Cardiovasc J. 2019:1-6.doi:10.1080/14017431.2019.1698761.
Abstract
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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https://www.tandfonline.com/doi/abs/10.1080/14017431.2019.1698761?journalCode=icdv20
http://web.b.ebscohost.com/ehost/command/detail?vid=0&sid=cc396e5a-3584-47d7-a045-da7d622d249c%40pdc-v-sessmgr03&bdata=JkF1dGhUeXBlPWlwLHNzbyZzaXRlPWVob3N0LWxpdmU%3d#jid=2UX&db=aph
ae974a485f413a2113503eed53cd6c53
10.1080/14017431.2019.1698761
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