Kowalewski Mariusz, Pasierski Michał, Finke Janina, Kołodziejczak Michalina, Staromłyński Jakub, Litwinowicz Radosław, Filip Grzegorz, Kowalówka Adam, Wańha Wojciech, Bławat Przemysław, Łoś Andrzej, Stefaniak Sebastian, Wojakowski Wojciech, Jemielity Marek, Rogowski Jan, Deja Marek, Jagielak Dariusz, Bartus Krzysztof, Sierakowska Katarzyna, Mariani Silvia, Li Tong, Ravaux Justine Mafalda, Matteucci Matteo, Ronco Daniele, Jiritano Federica, Fina Dario, Martucci Gennaro, Meani Paolo, Raffa Giuseppe Maria, Malvindi Pietro Giorgio, Lorusso Roberto, Suwalski Piotr
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
Heart Rhythm. 2022 Sep;19(9):1442-1449. doi: 10.1016/j.hrthm.2022.04.007. Epub 2022 Apr 13.
Among patients referred for cardiac surgery, atrial fibrillation (AF) is a common comorbidity and a risk factor for postoperative arrhythmias (eg, sinus node dysfunction, atrioventricular heart block), including those requiring permanent pacemaker (PPM) implantation.
The purpose of this study was to evaluate the prevalence and long-term survival of postoperative PPM implantation in patients with preoperative AF who underwent valve surgery with or without concomitant procedures.
Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During the study period, 11,949 patients underwent valvular (aortic, mitral, or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to postoperative PPM status.
PPM implantation after surgery was necessary in 2.5% of patients, with significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P <.001), cardiopulmonary bypass time (P = .024), and endocarditis (P = .014) were shown to be risk factors for PPM. Over long-term follow-up, PPM was not associated with increased mortality compared to no PPM (hazard ratio 0.96; 95% confidence interval 0.77-1.19; P = .679). SA was not associated with PPM implantation. However, SA improved survival regardless of PPM status (log rank P <.001).
In patients with preoperative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.
在接受心脏手术的患者中，心房颤动（AF）是一种常见的合并症，也是术后心律失常（如窦房结功能障碍、房室传导阻滞）的危险因素，包括那些需要植入永久起搏器（PPM）的情况。
本研究旨在评估术前房颤患者在接受瓣膜手术（伴或不伴其他相关手术）后植入PPM的发生率及长期生存率。
本分析基于HEIST（心房颤动和室上性心动过速心脏手术）注册研究。在研究期间，11949例患者接受了瓣膜（主动脉瓣、二尖瓣或三尖瓣置换或修复）手术和/或手术消融（SA），并根据术后PPM状态进行分层。
2.5%的患者术后需要植入PPM，根据手术类型的不同有显著差异（从二尖瓣修复的1.1%到二尖瓣和三尖瓣联合手术的3.3%）。在多因素逻辑回归模型中，三尖瓣干预（P<.001）、体外循环时间（P=.024）和心内膜炎（P=.014）被证明是PPM植入的危险因素。在长期随访中，与未植入PPM相比，植入PPM与死亡率增加无关（风险比0.96；95%置信区间0.77-1.19；P=.679）。SA与PPM植入无关。然而，无论PPM状态如何，SA均能提高生存率（对数秩检验P<.001）。
在术前房颤患者中，瓣膜手术或SA后需要植入PPM并非罕见，SA不影响其发生率，但实际上可提高长期生存率。
