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Permanent pacing and conduction recovery in patients undergoing cardiac surgery for active infective endocarditis in an Australian Tertiary Center
Author(s) -
AlKaisey Ahmed M.,
Chandra Nikhil,
Ha Francis J.,
AlKaisey Yasir M.,
Vasanthakumar Sheran,
Koshy Anoop N.,
Anderson Robert D.,
Ord Michelle,
Srivastava Piyush M.,
O'Donnell David,
Lim Han S.,
Matalanis George,
Teh Andrew W.
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13963
Subject(s) - medicine , odds ratio , infective endocarditis , confidence interval , surgery , single center , retrospective cohort study , univariate analysis , qrs complex , cardiology , anesthesia , endocarditis , pr interval , multivariate analysis , heart rate , blood pressure
Background Postoperative heart block is common among patients undergoing surgery for infective endocarditis (IE). Limited data exists allowing cardiologists to predict who will require permanent pacemaker (PPM) implantation postoperatively. We aimed to determine the rate of postoperative PPM insertion, predictors for postoperative PPM, and describe PPM utilization and rates of device‐related infection during follow‐up. Materials and Methods A retrospective analysis was performed of 191 consecutive patients from a single institution who underwent cardiac surgery for IE between 2001 and 2017. Preoperative and operative predictors for postoperative PPM were evaluated using univariate and multivariate logistic regression. Results The rate of postoperative PPM implantation was 11% (17/154). The PPM group had more preoperative prolonged PR interval alone (33% vs 12%; P = .03), coexistent prolonged PR and QRS durations (13% vs 2%; P = .01), infection beyond the valve leaflets (82% vs 41%; P = .001), aortic root debridement (65% vs 23%; P = <.001), patch repair (47% vs 20%; P = .01), postoperative prolonged PR interval (50% vs 24%; P = .01), and prolonged QRS duration (47% vs 15%; P = .001). On multivariate analysis, infection beyond the valve leaflets emerged as an independent predictor for postoperative PPM (odds ratio, 1.94, 95% confidence interval, 1.14‐3.28; P = .014). A reduction in PPM utilization was observed in five patients while eight patients continued to show significant ventricular pacing with no underlying rhythm at 12 months. There were no device‐related infections. Conclusion Postoperative PPM was required in 11% of patients undergoing surgery for IE over a 16‐year period. Infection beyond the valve leaflet was an independent predictor for postoperative PPM insertion.