Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
Department of Cardiology, Wah Medical College, Wah, Pakistan.
Pacing Clin Electrophysiol. 2022 May;45(5):681-687. doi: 10.1111/pace.14484. Epub 2022 Apr 9.
As the established surgical mitral valve replacement (MVR) expands toward various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using antiarrhythmic drugs, atrial fibrillation ablation, and double valve replacement were predictors of PPM implantation post-MVR. Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and antiarrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR.
随着既定的外科二尖瓣置换术 (MVR) 向各种当代技术和进入途径扩展，需要确定与手术相关的并发症的预测因素和负担，包括对永久性起搏器 (PPM) 植入的需求。系统地搜索了数字数据库，以确定报告 MVR 后 PPM 植入发生率的研究。提取了详细的研究和患者基线特征，包括研究类型、样本量、随访、MVR 后 PPM 植入数量、年龄、性别和基线心电图异常。最终分析共纳入了 12 项研究，共招募了 37124 名患者。总体而言，2820 名（7.6%）患者需要 PPM，净率为 1.7%至 10.96%。MVR 后房室（AV）传导阻滞是 PPM 最常见的指征，其次是窦房结功能障碍和心动过缓。年龄、男性、先前存在的合并症、先前的 CABG、心律失常或使用抗心律失常药物史、房颤消融和双瓣置换是 MVR 后 PPM 植入的预测因素。年龄、男性、糖尿病和肾功能损害等合并症、先前的 CABG、双瓣置换和抗心律失常药物是接受 MVR 患者 PPM 植入的阳性预测因素。
