LAUSR

BACKGROUND Among patients referred for cardiac surgeries, atrial fibrillation (AF) is a common comorbidity and a risk factor for post-operative arrhythmias (such as sinus node dysfunction or atrioventricular heart blocks), including those requiring permanent pacemaker (PPM) implantation. OBJECTIVE The current study aimed to evaluate the prevalence and long-term survival of post-operative PPM implantation in patients with pre-operative AF who underwent valve surgery with or without concomitant procedures. METHODS Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During study period 11,949 patients underwent valvular (aortic, mitral or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to post-operative PPM status. RESULTS Permanent pacemaker implantation after surgery was necessary in 2.5% of patients, with a significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P<0.001), cardio-pulmonary bypass time (P=0.024) and endocarditis (P=0.014) were shown to be risk factors for PPM. Over long-term follow-up PPM was not associated with increased mortality as compared to no PPM: Hazard Ratio 0.96; 95% Confidence Intervals 0.77-1.19; P=0.679. Surgical ablation was not associated with PPM implantation; in the same time, SA improved survival regardless of PPM status (log rank P<0.001). CONCLUSION In patients with pre-operative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.