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Pacemaker implantation after mitral valve surgery tied to higher risk of 1-year mortality

22 May 2019

The risk factors and outcomes associated with an increased risk of permanent pacing include atrial fibrillation (AF) ablation, multivalve surgery and New York Heart Association (NYHA) functional class III/IV, a recent study has found.

In addition, permanent pacemaker (PPM) implantation following mitral valve surgery (MVS) appears to increase the risk of 1-year mortality.

The investigators randomized 243 patients with AF and without previous PPM placement to MVS alone (n=117) or MVD + ablation (n=126). Those assigned to the ablation group were further randomized to pulmonary vein isolation (PVI; n=62) or the biatrial maze procedure (n=64). Competing risk models were utilized to examine the association among PPM and baseline and operative risk factors, as well as the effect of PPM on time to discharge, readmissions and 1-year mortality.

Of the patients, 35 (14.4 percent) received a PPM within the first year, and 29 (83 percent) of these recipients underwent implantation during the index hospitalization. PPM implantation was most frequent in patients randomized to MVS + biatrial maze (25 percent), followed by MVS + PVI (16.1 percent) and MVS alone (7.7 percent).

There were similar indications for PPM among patients who underwent MVS with and without ablation. Ablation, multivalve surgery and NYHA functional class III/IV were independently associated with PPM implantation.

Patients who received PPMs had a longer length of stay after surgery, but this was nonsignificant when adjusted for randomization assignment (MVS vs ablation) and age (hazard ratio [HR], 0.81; 95 percent CI, 0.61–1.08; p=0.14). PPM implantation did not increase the rate of 30-day readmissions (HR, 1.43; 0.50–4.05; p=0.50).

After adjustment for randomization assignment, age and NYHA functional class, an association was observed between the need for PPM and a higher risk of 1-year mortality (HR, 3.21; 1.01–10.17; p=0.05).

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