Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.

Autor:	DeRose JJ Jr; Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York., Mancini DM; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: donna.mancini@mountsinai.org., Chang HL; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Argenziano M; Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York., Dagenais F; Department of Surgery, Institut de Cardiologie et Pneumologie de Québec, Québec, Canada., Ailawadi G; Section of Adult Cardiac Surgery, University of Virginia, Charlottesville, Virginia., Perrault LP; Department of Surgery, Montreal Heart Institute, Québec, Québec, Canada., Parides MK; Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York., Taddei-Peters WC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland., Mack MJ; Cardiovascular Surgery, Baylor Scott and White Health, Plano, Texas., Glower DD; Department of Surgery, Duke University Medical Center, Durham, North Carolina., Yerokun BA; Department of Surgery, Duke University Medical Center, Durham, North Carolina., Atluri P; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Mullen JC; Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada., Puskas JD; Department of Cardiovascular Surgery, Mount Sinai Heart at Saint Luke's, New York, New York., O'Sullivan K; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Sledz NM; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Tremblay H; Department of Surgery, Institut de Cardiologie et Pneumologie de Québec, Québec, Canada., Moquete E; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Ferket BS; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Moskowitz AJ; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Iribarne A; Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Gelijns AC; International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., O'Gara PT; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts., Blackstone EH; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio., Gillinov AM; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2019 May 21; Vol. 73 (19), pp. 2427-2435.
DOI:	10.1016/j.jacc.2019.02.062
Abstrakt:	Background: The incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone. Objectives: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS. Methods: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality. Results: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class. Conclusions: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370). (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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