Permanent Cardiac Pacing after Cardiac Operations

From January 1980 through December 1990, implantation of a permanent pacemaker was performed in 34 patients following open heart surgery. The patients were divided into two groups according to the clinical indications for implantation of permanent pacemakers. Group 1 (9 patients) had surgical atrioventricular block, and Group 2 (25 patients) had sick sinus syndrome. Tricuspid valve surgery was involved in 67% of Group 1 and 64% of Group 2. Adams-Stokes syncopal attack was the prime indication for permanent pacing in 100% of Group 1 and in 72% of Group 2. There were 2 operative deaths in Group 1, and no deaths in Group 2 (22% in Group 1 vs. 0% in Group 2, p < 0.005). Causes of the deaths were not related to the pacemaker implantation but to congestive heart failure following surgery. Among 32 survivors, there were 2 late deaths in Group 1, and 4 deaths in Group 2 (25% in Group 1 vs. 16% in Group 2, p < 0.05). The overall actuarial survival rate at 10 years was 82.1 +/- 2.8%. However, the actuarial survival rate of patients in Group 1 is 70.2 +/- 4.1%, which is statistically less than 85.4 +/- 2.2% in Group 2 (p < 0.01). As judged by these results, patients in Group 1 should be followed on a regular out-patient basis even if they are asymptomatic and there is no evidence of pacemaker failure.