Socie Pierre, Nicot Florence, Baudinaud Pierre, Estagnasie Philippe, Brusset Alain, Squara Pierre, Nguyen Lee S
Critical Care Medicine Department, CMC Ambroise Paré, Neuilly-sur-Seine, France.
Critical Care Medicine Department, CMC Ambroise Paré, Neuilly-sur-Seine, France.
Am J Cardiol. 2017 Nov 15;120(10):1841-1846. doi: 10.1016/j.amjcard.2017.07.090. Epub 2017 Aug 8.
Best timing for permanent pacemaker implantation to treat complete atrioventricular block (AVB) after cardiac surgery is unclear, as late pacemaker dependency was found low in recent observational studies. This study aimed to identify factors associated with spontaneous recovery from AVB. In a prospective and observational cohort, all patients who underwent cardiothoracic surgery during a 14-month-period were included (n = 1,200). Risk factors of postoperative AVB were assessed by logistic regression. Among patients who developed AVB, variables associated with recovery from AVB were assessed by Cox and logistic regression. Overall incidence of postoperative AVB was 6.0%. Risk factors of AVB were age (OR 1.03 [1.00 to 1.06], p = 0.023); female gender (OR 2.06 [1.24 to 3.41], p = 0.005), active endocarditis (OR 3.31 [1.33 to 8.26], p = 0.01), and aortic valve replacement (OR 3.17 [1.92 to 5.25], p <0.001). Among aortic valve replacement, sutureless aortic valve replacement was associated with more AVB (26.7% vs 8.1%, p <0.01). Recovery from AVB occurred in 30 patients (41.7%) in a median period of 3 days [interquartile range = 1;5]. Among patients who would recover from AVB, 90% of patients did so before day 7. None of the studied variable was independently associated with recovery from AVB. In conclusion, identified risk factors of postoperative AVB after cardiac surgery were age, female gender, endocarditis, and aortic valve replacement. Because most patients who would recover did so before day 7, this study validates modern guidelines suggesting permanent pacemaker implantation on day 7.
心脏手术后植入永久性起搏器治疗完全性房室传导阻滞（AVB）的最佳时机尚不清楚，因为在最近的观察性研究中发现晚期起搏器依赖率较低。本研究旨在确定与AVB自发恢复相关的因素。在一个前瞻性观察队列中，纳入了在14个月期间接受心胸手术的所有患者（n = 1200）。通过逻辑回归评估术后AVB的危险因素。在发生AVB的患者中，通过Cox和逻辑回归评估与AVB恢复相关的变量。术后AVB的总体发生率为6.0%。AVB的危险因素包括年龄（OR 1.03 [1.00至1.06]，p = 0.023）；女性（OR 2.06 [1.24至3.41]，p = 0.005），活动性心内膜炎（OR 3.31 [1.33至8.26]，p = 0.01），以及主动脉瓣置换术（OR 3.17 [1.92至5.25]，p <0.001）。在主动脉瓣置换术中，无支架主动脉瓣置换术与更多的AVB相关（26.7%对8.1%，p <0.01）。30例患者（41.7%）在中位时间3天[四分位间距= 1；5]内从AVB中恢复。在将从AVB中恢复的患者中，90%的患者在第7天之前恢复。所研究的变量均与从AVB中恢复无关。总之，确定的心脏手术后术后AVB的危险因素是年龄、女性、心内膜炎和主动脉瓣置换术。由于大多数将恢复的患者在第7天之前恢复，本研究验证了现代指南建议在第7天植入永久性起搏器。
