El-Chami Mikhael F, Binongo José Nilo G, Levy Mathew, Merchant Faisal M, Halkos Michael, Thourani Vinod, Lattouf Omar, Guyton Robert, Puskas John, Leon Angel R
Division of Cardiology, Department of Medicine, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia.
Am J Cardiol. 2015 Jul 1;116(1):88-91. doi: 10.1016/j.amjcard.2015.03.046. Epub 2015 Apr 8.
The aim of this study was to retrospectively investigate whether performing surgical atrial fibrillation (AF) ablation in conjunction with cardiac surgery (CS) increases the risk for postoperative permanent pacemaker (PPM) requirement. The 30-day risk for PPM requirement was analyzed in consecutive patients who underwent CS from January 2007 to August 27, 2013. Patients were divided into 3 groups: (1) those who underwent AF ablation concomitant with CS (AF ABL), (2) patients with any history of AF who underwent surgery who did not undergo ablation (AF NO ABL), and (3) those with no histories of AF who underwent surgery (NO AF). Logistic regression analysis was performed adjusting for age, gender, and surgery type. Of 13,453 CS patients, 353 (3%) were in the AF ABL group, 1,701 (12%) in the AF NO ABL group, and 11,399 (85%) in the NO AF group. A total of 7,651 patients (57%) underwent coronary artery bypass grafting, 4,384 (33%) underwent valve surgery, and 1,418 (10%) underwent coronary artery bypass grafting and valve surgery. The overall PPM risk was 1.6% (212 of 13,453); risk was 5.7% (20 of 353) in the AF ABL group, 3.1% (53 of 1,701) in the AF NO ABL group, and 1.2% (139 of 11,399) in the NO AF group. The unadjusted and adjusted odds of PPM were higher in the AF ABL and AF NO ABL groups than in the NO AF group (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7 to 4.4, and adjusted OR 1.7, 95% CI 1.2 to 2.4, respectively). The unadjusted OR comparing the AF ABL group and the AF NO ABL group was significant (unadjusted OR 1.9, 95% CI 1.9 to 3.2); however, the OR adjusted for surgery type, age, and gender showed a trend toward significance (adjusted OR 1.6, 95% CI 0.9 to 2.7). In conclusion, in this large cohort of patients who underwent CS, surgical AF ablation appeared to carry an increased risk for postoperative PPM implantation.
本研究的目的是回顾性调查在心脏手术（CS）的同时进行外科房颤（AF）消融是否会增加术后永久性起搏器（PPM）植入的风险。对2007年1月至2013年8月27日连续接受CS的患者进行了PPM植入30天风险的分析。患者分为3组：（1）在CS的同时接受AF消融的患者（AF ABL），（2）有AF病史但未接受消融的手术患者（AF NO ABL），以及（3）无AF病史的手术患者（NO AF）。进行逻辑回归分析，并对年龄、性别和手术类型进行校正。在13453例CS患者中，AF ABL组有353例（3%），AF NO ABL组有1701例（12%），NO AF组有11399例（85%）。共有7651例患者（57%）接受了冠状动脉旁路移植术，4384例（33%）接受了瓣膜手术，1418例（10%）接受了冠状动脉旁路移植术和瓣膜手术。总体PPM风险为1.6%（13453例中的212例）；AF ABL组风险为5.7%（353例中的20例），AF NO ABL组为3.1%（1701例中的53例），NO AF组为1.2%（11399例中的139例）。AF ABL组和AF NO ABL组未经校正和校正后的PPM比值均高于NO AF组（校正后的比值比[OR]分别为2.7，95%置信区间[CI]为1.7至4.4，以及校正后的OR为1.7，95%CI为1.2至2.4）。比较AF ABL组和AF NO ABL组的未校正OR具有显著性（未校正OR为1.9，95%CI为1.9至3.2）；然而，校正手术类型、年龄和性别后的OR显示出显著趋势（校正后的OR为1.6，95%CI为0.9至2.7）。总之，在这一大群接受CS的患者中，外科AF消融似乎会增加术后PPM植入的风险。
