Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation
Joseph J DeRose Jr, Donna M Mancini, Helena L Chang, Michael Argenziano, François Dagenais, Gorav Ailawadi, Louis P Perrault, Michael K Parides, Wendy C Taddei-Peters, Michael J Mack, Donald D Glower, Babatunde A Yerokun, Pavan Atluri, John C Mullen, John D Puskas, Karen O'Sullivan, Nancy M Sledz, Hugo Tremblay, Ellen Moquete, Bart S Ferket, Alan J Moskowitz, Alexander Iribarne, Annetine C Gelijns, Patrick T O'Gara, Eugene H Blackstone, A Marc Gillinov, CTSN Investigators, Marissa A Miller, Wendy C Taddei-Peters, Dennis Buxton, Amy Connolly, Nancy L Geller, David Gordon, Neal O Jeffries, Albert Lee, Claudia S Moy, Ilana Kogan Gombos, Jennifer Ralph, Richard Weisel, Timothy J Gardner, Patrick T O'Gara, Eric A Rose, Annetine C Gelijns, Michael K Parides, Deborah D Ascheim, Alan J Moskowitz, Emilia Bagiella, Ellen Moquete, Helena Chang, Melissa Chase, Edlira Dobrev, Seth Goldfarb, Lopa Gupta, Katherine Kirkwood, Ron Levitan, Karen O'Sullivan, Jessica Overbey, Milerva Santos, Michael Weglinski, Paula Williams, Carrie Wood, Xia Ye, Michael Mack, Tracine Adame, Natalie Settele, Jenny Adams, William Ryan, Robert L Smith, Paul Grayburn, Frederick Y Chen, Anju Nohria, Lawrence Cohn, Prem Shekar, Sary Aranki, Gregory Couper, Michael Davidson, R Morton Bolman 3rd, Anne Burgess, Debra Conboy, Ray Blackwell, Roger Kerzner, Michael Banbury, Andrea M Squire, A Marc Gillinov, Eugene H Blackstone, Bruce Lytle, Tomislav Mihaljevic, Pamela Lackner, Leoma Berroteran, Diana Dolney, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Gregory Pattakos, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Sowmya Sreekanth, Peter K Smith, John H Alexander, Carmelo A Milano, Donald D Glower, Joseph P Mathew, J Kevin Harrison, Stacey Welsh, T Bruce Ferguson, Alan P Kypson, Evelio Rodriguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D Puskas, Vinod H Thourani, Robert Guyton, Jefferson Baer, Kim Baio, Alexis A Neill, Pierre Voisine, Mario Senechal, François Dagenais, Kim O'Connor, Gladys Dussault, Tatiana Ballivian, Suzanne Keilani, Robert E Michler, David A D'Alessandro, Joseph J DeRose Jr, Daniel J Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia Taub, Daniel Spevack, Roger Swayze, Nadia Sookraj, Louis P Perrault, Arsène-Joseph Basmadjian, Denis Bouchard, Michel Carrier, Raymond Cartier, Michel Pellerin, Jean François Tanguay, Ismael El-Hamamsy, André Denault, Jonathan Lacharité, Sophie Robichaud, David H Adams, Robin Varghese, Yael Mandel-Portnoy, Keith A Horvath, Philip C Corcoran, Michael P Siegenthaler, Mandy Murphy, Margaret Iraola, Ann Greenberg, Chittoor Sai-Sudhakar, Ayseha Hasan, Asia McDavid, Bradley Kinn, John C Mullen, Jonathan Choy, Steven Meyer, Emily Kuurstra, James S Gammie, Christopher R DeFilippi, Dino T Gaetani, Cindi A Young, Dana Beach, Julia Collins, Steven F Bolling, Francis D Pagani, Cathie Bloem, Michael A Acker, Y Joseph Woo, Mary Lou Mayer, Joseph E Bavaria, Wilson Y Szeto, Kenneth Margulies, Martin Keane, Helene Glassberg, Dinesh Jagasia, James Kirkpatrick, Irving L Kron, Gorav Ailawadi, Karen Johnston, John M Dent, John Kern, Jessica Keim, Sandra Burks, Kim Gahring, Abeel Mangi, Joseph Akar, David Yuh, Lynn Wilson, David A Bull, Patrice Desvigne-Nickens, Dennis O Dixon, Mark Haigney, Richard Holubkov, Alice Jacobs, Frank Miller, John M Murkin, John Spertus, Andrew S Wechsler, Frank Sellke, Cheryl L McDonald, Robert Byington, Neal Dickert, Dennis O Dixon, John S Ikonomidis, David O Williams, Clyde W Yancy, John M Canty Jr, James C Fang, Nadia Giannetti, Wayne Richenbacher, Vivek Rao, Karen L Furie, Rachel Miller, Sean Pinney, William C Roberts, Mary N Walsh, Judy Hung, Xin Zeng, Jean-Philippe Couderc, Dan Balda, Wayne Bowen, Mauri Wilson, Anne Schering, Joseph J DeRose Jr, Donna M Mancini, Helena L Chang, Michael Argenziano, François Dagenais, Gorav Ailawadi, Louis P Perrault, Michael K Parides, Wendy C Taddei-Peters, Michael J Mack, Donald D Glower, Babatunde A Yerokun, Pavan Atluri, John C Mullen, John D Puskas, Karen O'Sullivan, Nancy M Sledz, Hugo Tremblay, Ellen Moquete, Bart S Ferket, Alan J Moskowitz, Alexander Iribarne, Annetine C Gelijns, Patrick T O'Gara, Eugene H Blackstone, A Marc Gillinov, CTSN Investigators, Marissa A Miller, Wendy C Taddei-Peters, Dennis Buxton, Amy Connolly, Nancy L Geller, David Gordon, Neal O Jeffries, Albert Lee, Claudia S Moy, Ilana Kogan Gombos, Jennifer Ralph, Richard Weisel, Timothy J Gardner, Patrick T O'Gara, Eric A Rose, Annetine C Gelijns, Michael K Parides, Deborah D Ascheim, Alan J Moskowitz, Emilia Bagiella, Ellen Moquete, Helena Chang, Melissa Chase, Edlira Dobrev, Seth Goldfarb, Lopa Gupta, Katherine Kirkwood, Ron Levitan, Karen O'Sullivan, Jessica Overbey, Milerva Santos, Michael Weglinski, Paula Williams, Carrie Wood, Xia Ye, Michael Mack, Tracine Adame, Natalie Settele, Jenny Adams, William Ryan, Robert L Smith, Paul Grayburn, Frederick Y Chen, Anju Nohria, Lawrence Cohn, Prem Shekar, Sary Aranki, Gregory Couper, Michael Davidson, R Morton Bolman 3rd, Anne Burgess, Debra Conboy, Ray Blackwell, Roger Kerzner, Michael Banbury, Andrea M Squire, A Marc Gillinov, Eugene H Blackstone, Bruce Lytle, Tomislav Mihaljevic, Pamela Lackner, Leoma Berroteran, Diana Dolney, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Gregory Pattakos, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Sowmya Sreekanth, Peter K Smith, John H Alexander, Carmelo A Milano, Donald D Glower, Joseph P Mathew, J Kevin Harrison, Stacey Welsh, T Bruce Ferguson, Alan P Kypson, Evelio Rodriguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D Puskas, Vinod H Thourani, Robert Guyton, Jefferson Baer, Kim Baio, Alexis A Neill, Pierre Voisine, Mario Senechal, François Dagenais, Kim O'Connor, Gladys Dussault, Tatiana Ballivian, Suzanne Keilani, Robert E Michler, David A D'Alessandro, Joseph J DeRose Jr, Daniel J Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia Taub, Daniel Spevack, Roger Swayze, Nadia Sookraj, Louis P Perrault, Arsène-Joseph Basmadjian, Denis Bouchard, Michel Carrier, Raymond Cartier, Michel Pellerin, Jean François Tanguay, Ismael El-Hamamsy, André Denault, Jonathan Lacharité, Sophie Robichaud, David H Adams, Robin Varghese, Yael Mandel-Portnoy, Keith A Horvath, Philip C Corcoran, Michael P Siegenthaler, Mandy Murphy, Margaret Iraola, Ann Greenberg, Chittoor Sai-Sudhakar, Ayseha Hasan, Asia McDavid, Bradley Kinn, John C Mullen, Jonathan Choy, Steven Meyer, Emily Kuurstra, James S Gammie, Christopher R DeFilippi, Dino T Gaetani, Cindi A Young, Dana Beach, Julia Collins, Steven F Bolling, Francis D Pagani, Cathie Bloem, Michael A Acker, Y Joseph Woo, Mary Lou Mayer, Joseph E Bavaria, Wilson Y Szeto, Kenneth Margulies, Martin Keane, Helene Glassberg, Dinesh Jagasia, James Kirkpatrick, Irving L Kron, Gorav Ailawadi, Karen Johnston, John M Dent, John Kern, Jessica Keim, Sandra Burks, Kim Gahring, Abeel Mangi, Joseph Akar, David Yuh, Lynn Wilson, David A Bull, Patrice Desvigne-Nickens, Dennis O Dixon, Mark Haigney, Richard Holubkov, Alice Jacobs, Frank Miller, John M Murkin, John Spertus, Andrew S Wechsler, Frank Sellke, Cheryl L McDonald, Robert Byington, Neal Dickert, Dennis O Dixon, John S Ikonomidis, David O Williams, Clyde W Yancy, John M Canty Jr, James C Fang, Nadia Giannetti, Wayne Richenbacher, Vivek Rao, Karen L Furie, Rachel Miller, Sean Pinney, William C Roberts, Mary N Walsh, Judy Hung, Xin Zeng, Jean-Philippe Couderc, Dan Balda, Wayne Bowen, Mauri Wilson, Anne Schering
Abstract
Background: The incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone.
Objectives: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS.
Methods: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality.
Results: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class.
Conclusions: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370).
Keywords: biatrial maze; cardiac surgery; permanent pacemaker; pulmonary vein isolation; valvular heart disease.
Conflict of interest statement
Disclosures: Dr. Gillinov reports: consulting for Edwards Lifesciences, Medtronic, AtriCure, Abbott, CryolLife, ClearFlow; royalties and equity rights for ClearFlow; institutional royalties for AtriCure. Dr. Mack reports: Co-PI relationship with Edwards Lifesciences and Abbott Vascular; Executive Board member for Medtronic, all uncompensated. All other authors have nothing to disclose.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Source: PubMed