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JACC March 6, 2002 1203-133 Predictors of Early Permanent Pacemaker Implantation Following Aortic Valve Replacement

Background: Defects of the conducting system are common in patients with aortic valve disease. Aortic valve replacement (AVR) may result in the development of further conduction abnormalities and necessitate permanent pacemaker implantation (PPM). We sought to identify predictors of early post-operative PPM in patients undergoing AVR. Methods: We assessed 354 consecutive patients undergoing AVR at a tertiary cardiac unit between January 1999 and July 2000. Data were incomplete in 4 patients and a further 8 had a pre-operative PPM Results for the remaining 342 (97%) patients are presented (212 males, age 67±14 years, mean±SD). The mean length of patient follow-up was 114±192 days (range 2 to 938 days). The major indications for AVR were significant valvular stenosis (n=224), regurgitation (An, n=70), or infective endocarditis (n=25). The majority of procedures were elective (90%) and only one was a redo. Pre-operative conducting system disease, as determined from the resting electrocardiogram (first degree heart block, left or right bundle branch block, left anterior hemi-block), was present in 26% of patients. Results: Post-operatively 29 (8.5%) patients required PPM Receiver operating characteristic (ROC) analysis demonstrated that the best cut-off vatue of aortic valve diameter (AVD) for predicting PPM requirement was 24mm (area under curve=0.60, 95% CI 0.55 to 0.65). 13% of patients with an AVD >24ram required a PPM as compared to 6% of those with an AVD -<24mm (p=0.03). Patients with AR as an indication for surgery were more likely to require a P.PM as opposed to those without (16% vs 7%, p=0.01). Significantly more patients with pre-operative conducting system disease needed PPM (16% vs 6%, p<0.01). Conclusions: The implantation of PPM following AVR is a relatively common occurrence, and should be discussed with the patient as part of the preoperative consent process. We found that a large AVD, pre-operativo An, and pre-existing conducting disease were all significant predictors of PPM requirement.