Interventional cardiology

Practical clue to pacemaker need

Dependency on routine temporary pacing after open-heart surgery is the strongest predictor of the need for a permanent pacemaker, Australian research shows.

The retrospective study comprised 48 patients requiring cardiac implantable electronic device (CIED) implantation after cardiac surgery between 2013 and 2017 at the Austin Hospital.

Patients included those who had undergone CABG or valve surgery or both.

The study, presented at the RACP Congress in Auckland, found that postoperative dependency on temporary pacing was a consistent and significant predictor of long term CIED dependency (Odds Ratio >6.53)

Other variables such as type of surgery, pre-surgery conduction pathology or peri-operative antiarrhythmic medications were not significant predictors of CIED dependency.

The study found no complications from the pacemaker implantation procedure.

Dr Ivan Subiakto, clinical electrophysiology fellow at the Austin, Melbourne, at the time of the study, told the limbic that the findings were commonsense.

“If during your stay in hospital after surgery you depend on that wire to keep your heart going, then it’s self explanatory that you might need a pacemaker.”

“Interestingly though, some of the previous studies have not been able to say that. They’ve suggested variables such as being female or being older, etcetera but there’s been no solid conclusion. Our study happened to be one of the first.”

Speaking after the RACP Congress, he said the findings provided some confidence and a timeframe for conversations about the need for a pacemaker.

“Unfortunately some people never go back to normal [pacing] and that’s when the cardiologist and the surgeon decide together about proceeding to a pacemaker or waiting.”

“For example, this patient is five days post-surgery – rather than waiting longer, we can probably put the pacemaker in at this stage and the patient can probably go home earlier.”

Dr Subiakto said as well as improving patient outcomes, a timely decision to insert a pacemaker could also improve hospital outcomes.

“You can actually help the system, rather than keeping patients in ICU or coronary care, by putting in a pacemaker and moving patients sooner through to rehab.”

He said the Austin Hospital was quite conservative with pacemakers typically implanted at 7-14 days.

“Importantly with our outcomes, those who underwent pacemaker implantation didn’t have any immediate complications from the pacemaker itself. Basically, in safe hands and a good unit, a pacemaker is safe.”

He said infection was probably one of the most common reasons to delay a pacemaker procedure.

Larger, prospective studies were required to confirm the findings and guide patient selection for CIED implantation after cardiac surgery.

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