Sinus node dysfunction and related permanent pacemaker implantation after major cardiac surgeries, systematic review, and meta-analysis

Abstract

BackgroundThere is no concise evidence or clinical guidelines regarding the incidence of sinus node dysfunction (SND) and permanent pacemaker (PPM) implantation following cardiac surgeries and their management approaches.ObjectiveWe aim to systematically review current evidence on the prevalence of SND, PPM implantation concerning it, and its risk factors in patients undergoing cardiac surgery.MethodFour electronic databases (Cochrane Library, Medline, SCOPUS, and Web of Science) were systematically searched for articles regarding SND after cardiovascular surgeries and reviewed by two independent researchers, and a third review in case of discrepancies. Using the random-effects model, a proportion meta-analysis was performed on data regarding PPM implantation. Subgroup analysis was performed for different interventions, and the possible effect of different covariates was evaluated using meta-regression.ResultsFrom the initial 2012 unique records, 87 were included in the study, and results were extracted. Pooled data from 38,519 patients indicated that the overall prevalence of PPM implantation due to SND after cardiac surgery was 2.87% (95% CI [2.09; 3.76]). The incidence of PPM implantation in the first post-surgical month was 2.707% (95% CI [1.657; 3.952]). Among the four main intervention groups, including valve, maze, valve-maze, and combined surgeries, maze surgery was associated with the highest prevalence (4.93%; CI [3.24; 6.92]). The pooled prevalence of SND among studies was 13.71% (95% CI [8.13; 20.33]). No significant relationship was observed between PPM implantation and age, gender, cardiopulmonary bypass time, or aortic cross-clamp time.ConclusionBased on the present report, patients undergoing the maze and maze-valve procedures are at higher risk of post-op SND, whereas lone valve surgery had the lowest prevalence of PPM implantation.Systematic Review RegistrationPROSPERO (CRD42022341896).

Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high‐risk infected device extraction

“…Patients with congenital heart disease are at increased risk for cardiac pacing from early and late atrioventricular block (as high as 0.7%) and sinus node dysfunction with the incidence of pacing for sinus node dysfunction as high as 2.87% 1,2 . Atrial and ventricular pacing may be present due to atriotomy scars or atrial arrhythmia ablations with subsequent sinus node dysfunction or may have a ventricular septal defect or altered His‐Purkinje anatomy due to their underlying defect 1,2 . The Micra (Medtronic) leadless pacemaker use has been described in adult congenital patients with repaired or unrepaired congenital heart disease 3–5 .…”

“…1,2 Atrial and ventricular pacing may be present due to atriotomy scars or atrial arrhythmia ablations with subsequent sinus node dysfunction or may have a ventricular septal defect or altered His-Purkinje anatomy due to their underlying defect. 1,2 The Micra (Medtronic) leadless pacemaker use has been described in adult congenital patients with repaired or unrepaired congenital heart disease. [3][4][5] We present the first description of two separate types of leadless pacing devices used in the same patient with complex congenital anatomy with moderate tricuspid regurgitation and requiring atrial and ventricular pacing who was a complex prohibitive risk for a standard permanent pacemaker.…”

Fragmented QRS, a strong predictor of mortality and major arrhythmic events in patients with nonischemic cardiomyopathy: A systematic review and meta‐analysis

“…8,9 Twelve-lead electrocardiography (ECG) is an important noninvasive method for evaluating patients with cardiovascular disorders, and association between ECG markers with the prognosis of cardiomyopathies. [10][11][12] Fragmented QRS (fQRS), defined as various RSR' patterns, has been identified as an ECG marker of myocardial scarring and fibrosis, 13 which could have a prognostic value for poor cardiovascular outcomes and mortality in various cardiac disorders, including coronary artery disease, 14 Brugada syndrome 15 and heart failure (HF). 16 During the past decade, accumulating studies have suggested that the presence of fQRS on ECG may be a predictive factor of higher risk of MAEs and mortality in various types of cardiomyopathies.…”