INDICATIONS, EFFECTIVENESS, AND LONG-TERM DEPENDENCY IN PERMANENT PACING AFTER CARDIAC-SURGERY

The purposes of this study were to define predictors of long-term pace maker dependency in patients having permanent pacemakers implanted sho rtly after cardiac surgery, and to evaluate short-and long-term result s and survival in this population. Data from 120 adult patients with i mplantation since 1980 were retrospectively analyzed. Acute and chroni c complication rates (4.2% and 16.6%, respectively) were not higher th an those expected in the general paced population. In addition, contin uous rhythm was evaluated by use of pacemaker inhibition in a subgroup of 20 patients to verify the validity of clinical criteria for pacema ker dependency. Of the patients evaluated for dependency, 41% eventual ly became nondependent. Prolonged monitoring with an inhibited pacemak er confirmed the accuracy of our method of clinical evaluation of pace maker dependency. Significant predictors of long-term pacemaker depend ency were complete atrioventricular block as the indication and bypass time of > 120 minutes (by multivariate and univariate analyses, respe ctively). Postoperative complete atrioventricular block is the most im portant predictor of pacemaker dependency, enabling an earlier decisio n on permanent pacemaker implantation (no later than the sixth and the ninth postoperative days for wide-complex and narrow-complex escape, respectively). Further prospective studies are needed to define optima l implantation times for indications other than complete atrioventricu lar block. (C) 1997 by Excerpta Medica, Inc.