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Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience.

Abstract：

:This was a retrospective study documenting all pacemaker implantations (PMIs) secondary to postoperative atrioventricular block. A total of 26 patients were included between 2011 and 2020. The incidence rate was 1.8%, with a median follow-up time of 4.5 years. At the time of the initial PMI, the median weight was 5 kg, and the median generator longevity was 45 months. Mean cardiopulmonary bypass and aortic clamp times were significantly longer among surgeries complicated with PMI (P≤ 0.05). Trisomy 21 patients were 4 times more likely to need a PMI (95% CI 1.8-9, P < 0.001). The mean Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgery scores were higher in patients with PMI. All initial PMIs were epicardial (18 single chamber). Most patients underwent ventricular septal defect closure (isolated or complex), except for 5 patients who underwent left-sided surgery. Pacing-induced dilated cardiomyopathy occurred in 3 patients. All implanted leads were functional except for 2 leads with high thresholds and another biventricular system infection. There was a 31% rate of pacing reintervention.Conclusion: PMI resulted in significant morbidity but without mortality. The highest risk for PMI was left ventricular outflow tract repair, trisomy 21, prolonged cardiopulmonary bypass, and aortic cross times. What is Known: •Incidence rate for postoperative atrioventricular block requiring pacemaker was at 1.8%, similar to previously published reports. •Longer cardiopulmonary bypass and aortic cross-clamp times were associated with higher risk for developing postoperative persistent atrioventricular block. What is New: •Incidence for persistent atrioventricular block requiring pacemaker was highest among left ventricular outflow tract surgery at 8.6%. •Following all intracardiac repair, Down syndrome patients were 4 times more likely to need a pacemaker implantation compared to the non-syndromic group.

journal_name

Eur J Pediatr

journal_title

European journal of pediatrics

authors

Ebrahim MA,Ashkanani HK,Alramzi RS,Malhas ZI,Al-Bahrani M,Sadek AA,Elsayed MA,Lyubomudrov VG

doi

10.1007/s00431-020-03739-9

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

1867-1872

issue

eissn

0340-6199

issn

1432-1076

pii

10.1007/s00431-020-03739-9

journal_volume

179

pub_type

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Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience.