Predictors and Risk of Pacemaker Implantation After the Cox-Maze IV Procedure

Abstract

Background The incidence of and causes for permanent pacemaker implantation (PPM) after surgical arrhythmia procedures remain poorly understood because of the varied lesion patterns and energy sources reported in small series. This study characterized the incidence, indications, and risk factors for PPM after the Cox-maze IV (CMIV) procedure when performed as either a lone or a concomitant procedure. Methods A retrospective analysis of 340 patients undergoing a CMIV as either a lone (n = 112) or a concomitant (n = 228) procedure was conducted. The incidence, indication, and variables associated with PPM implantation within 1 year of the operation were assessed. Follow-up was conducted at 30 days and 1 year and was 90% complete. Results The incidence of PPM after a lone CMIV procedure was 5%. Patients with concomitant cardiac operations had a nonsignificant increase in PPM insertion at 30 days (11% vs 5%, p = 0.14) and 1 year (15% vs 6%, p = 0.06) when compared with lone CMIV patients. Of patients who required pacemakers, sinus node dysfunction was present in 79% (35/44) of patients in the entire series and in 88% (8/9) after lone CMIV. After PPM, 84% (37/44) of patients remained paced at last follow-up. Multivariate analysis identified age (odds ratio = 1.10 [1.06–1.14], p < 0.001) as the only variable associated with higher risk of a PPM after any CMIV procedure. Conclusions The risk of PPM implantation after a lone CMIV is 5% and increases with age. The need for a PPM after a CMIV is largely due to SA node dysfunction, which appears unlikely to recover. These data should help physicians counsel patients regarding the perioperative risks associated with the CMIV.

Acute Sinus Node Dysfunction after Atrial Ablation: Incidence, Risk Factors, and Management

“…)—the patient had immediate sinus arrest during ablation requiring pacing . Interestingly, although there is proximity of ablation lesions to the atrial arterial blood supply, the rate of SND requiring pacemaker implantation in our study was far lower than that reported following the surgical maze . This may result from nontransmural lesion formation with catheter ablation, in contrast to surgical maze …”

Concomitant Unipolar Radiofrequency Ablation of Nonparoxysmal Atrial Fibrillation in Rheumatic and Degenerative Valve Disease

“…The most common complication was pacemaker implantation, which occurred in 17 patients (17%). This is in line with a very recent retrospective analysis of the predictors and risk of pacemaker implantation after the Cox‐Maze procedure, which found concomitant procedures to be associated with a non‐significantly higher risk than lone interventions (11% vs. 5%, p = 0.14 and 15% vs. 6%, p = 0.06, at 30 days and one year, respectively) . Another group reported a rate of pacemaker implantation at 30 days of 6.9%, in which a biatrial lesion set was the single predictor of pacemaker implantation.…”

Effectiveness of Surgical Ablation in Patients With Atrial Fibrillation and Aortic Valve Disease

“…This was much higher than we saw in patients undergoing a stand-alone CMPIV. (23) During the same time period our incidence of pacemaker implantation in patients undergoing isolated AVR was 6.7%. This high incidence may be explained by the older patient population and the complexity of the surgery performed in these patients.…”

“…Half of the patients requiring postoperative pacemaker implantation in this group were indicated for 3 rd -degree heart block, which is rarely seen following the stand-alone CMPIV. (23) Though there is some evidence to suggest patients with sinus node dysfunction improve after the CMP lesion sets,(24, 25) further studies will be needed to assess this complication.…”