Late Outcome and Predictors of Adverse Events Related to the Implantation of a Permanent Pacemaker in Patients with Isolated Congenital Atrioventricular Block

Abstract

Isolated congenital atrioventricular block (ICAVB) is a rare, and pacemaker implantation is the only effective treatment. We sought to identify the predictive factors of adverse events related to pacemaker implantation in ICAVB. This is a cohort study of patients diagnosed with ICAVB who underwent pacemaker implantation from 1980 to 2014 in a single center. During the studied period, a total of 647 patients underwent implantation of their first permanent cardiac pacemaker before 30 years of age. Of these, only 62 (9.5 %) were diagnosed with ICAVB. This condition was diagnosed in utero in 15 (24.2 %) cases, 5 (8.1 %) in the neonatal period, 32 (51.6 %) during childhood, and 10 (16.1 %) during adolescence and young adulthood. The presence of autoantibodies (anti-Ro/SSA) was observed in 41 % of mothers who underwent serological evaluation. Age at the time of the initial pacemaker implant was 9.8 ± 9 years. During a mean follow-up time of 15 years, 1 (1.7 %) death occurred due to infectious endocarditis. Complications related to pacemaker implant were reported in 24 patients (38.7 %). The number of complications was significantly higher in the group with an epimyocardial implantation site (HR 6; CI 2.45-14.95). Ventricular dysfunction occurred in 6 (11.7 %) patients; however, we were not able to identify any predictors of it. Our results showed a low mortality rate after permanent therapy. However, these patients exhibited high morbidity related to the pacemaker system, and the epimyocardial implant site was an independent predictor of complications. Predictors of left ventricular dysfunction were not found in the present study.

Analysis of postoperative complications and risk factors in patients with permanent pacemaker implantation

“…If these complications are not treated in a timely manner, the treatment efficacy and prognosis of PPI in patients might be affected, along with the progression of the disease. Therefore, PPI complications have become a focus of research among cardiovascular physicians (12,13). Relevant data have previously shown that the postoperative complication rate of patients with PPI is approximately 8.2-17.4%.…”

Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias

“…In this context, the patient's age is an aggravating factor for sudden death, since the risk of sustained ventricular tachycardia increases from 0.2% to 0.5% per year in operated and followed-up patients after 21 and 30 years old, respectively 7,8 . Some atrial arrhythmias, such as fibrillation and atrial flutter, are associated with a greater chance of death, predisposing to more severe ventricular arrhythmias 9 . Other mechanisms of sudden death result from anatomical changes that can cause hemodynamic impairment, embolism, myocardial infarction, or rupture of an aneurysm 10 .…”

“…The risk factors for sudden cardiac death that are considered in patients with TOF are left systolic ventricular dysfunction, presyncope, syncope, palpitations, QRS duration equals to or greater than 180 ms, non-sustained ventricular tachycardia, and induction of ventricular arrhythmias in an electrophysiological study (EPS) 11 . To mitigate sudden death, the induction of sustained ventricular tachyarrhythmias in EPS becomes an important tool in stratifying patients with these risk factors in the decision to implant a cardiac defibrillator 9 .…”