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

Abstract

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\u2009months. 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\u2009days after surgery, most commonly for complete AV block (n\u2009=\u200914) or symptomatic bradycardia (n\u2009=\u20098); Thirty-eight other patients (6.8%) had a PPM implanted >30\u2009days postoperatively, at a median of 43\u2009months after surgery (range 0‒181), most often for AV block (n\u2009=\u200913) or sick-sinus syndrome (n\u2009=\u200910). The cumulative incidence of PPM implantation at 1, 5, and 10\u2009years 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\u2009years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.