Key result
Early pacemaker implantation after cardiac surgery shows no difference in long-term pacemaker dependency versus late implantation.
Why the study?
It was unknown whether early (<7 days) permanent pacemaker implantation after cardiac surgery impacts long-term pacemaker dependency compared with late (≥7 days) implantation.
Does early (<7 days) pacemaker implantation after cardiac surgery reduce long-term pacemaker dependency compared to late (≥7 days) implantation?
Cohort (n=108)
Does early (<7 days) pacemaker implantation after cardiac surgery reduce long-term pacemaker dependency compared to late (≥7 days) implantation?
Absolute Event Rate: 66.7% vs 46.5%
p-value: p=.15
Early pacemaker implantation (<7 days) after cardiac surgery does not significantly affect long-term pacemaker dependency but is associated with a shorter hospital stay and less new-onset atrial fibrillation.
Early post-cardiac surgery pacemaker timing was not associated with long-term dependency; leaves open optimal timing pending prospective trials.
OBJECTIVE: We aimed to investigate pacemaker dependency after at least 1 year in patients with early (<7 days) implantation, compared to those who received a pacemaker ≥7 days after cardiac surgery. Secondary endpoints were length of hospital stay and in-hospital complications. METHODS: Retrospective analysis of 108 consecutive patients who received a pacemaker after cardiac surgery between 06/2012 and 06/2018. Characteristics and outcomes were compared between patients with early (<7 days) and late (≥7 days) implantation. Patients were followed up with evaluation of pacemaker dependency between April and June 2019. We identified predictors of dependency by logistic regression. RESULTS: In total, 63.9% were men, average age 71.9 ± 11.8 years; 32 (29.6%) had early implantation, and 76 (70.4%) late implantation. After a median 3.2 years [IQR 1.9, 4.5] of follow-up, 30 patients (27.8%) had died, and there was no difference in pacemaker dependency among survivors (66.7% vs. 46.5%, early vs. late respectively, p = .15). Patients in the early group had a shorter length of stay (11.5 [9.0, 14.0] vs. 15.0 [11.5, 20] days, p = .002) and less often had new-onset atrial fibrillation (AF) post-surgery (22.7% vs. 47.8%, p = .05). The only significant predictor of dependency was aortic valve replacement surgery (OR = 4.70, 95% CI [1.36 to 16.24]). CONCLUSION: Early implantation of a permanent pacemaker (<7 days after cardiac surgery) does not impact on the proportion of patients with long-term (>12 months) pacemaker dependency, but is associated with shorter length of stay and less frequent new-onset AF. These findings warrant prospective confirmation in randomized trials.
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Badoz et al. (2021) conducted a cohort in Pacemaker implantation after cardiac surgery (n=108). Early (<7 days) pacemaker implantation vs. Late (≥7 days) pacemaker implantation was evaluated on Pacemaker dependency after at least 1 year (p=.15). Early pacemaker implantation (<7 days) after cardiac surgery did not significantly affect long-term pacemaker dependency compared to late implantation (66.7% vs 46.5%, p=0.15).
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