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DOI: 10.1055/s-0036-1571773
Does Rhythm Recover after Pacemaker Implantation for Atrioventricular Conduction Disorder after Sutureless Aortic Valve Replacement?
Objectives: The majority of patients receiving permanent pacemaker (PM) implantation after conventional aortic valve replacement (AVR) do not recover from atrioventricular (AV) conduction disorder. The new generation of self-expandable sutureless aortic valve prostheses offers benefits in terms of reduced cardiac ischemia times, but leads to a higher rate of postoperative AV conduction disorders. Whether these patients recover from AV conduction disorders is not clear. This study analyzes the long-term PM dependency and recovery from AV conduction disorders during follow-up in patients receiving sutureless aortic valve prosthesis.
Methods: Between June 2010 and August 2013, a total of 105 patients underwent AVR with a sutureless Sorin Perceval® prosthesis at our center. Of these, 18 patients (17%, mean age 78 ± 5 years, 22% female) developed a significant conduction disorder necessitating PM implantation. Preoperative electrocardiogram (ECG) showed normal sinus rhythm in 39% (n = 7), right bundle branch block in 22% (n = 4), left anterior hemiblock in 17% (n = 3), bifascicular block (n = 3) in 17% and atrial fibrillation in 5% (n = 1) of patients. PM implantation was performed after a mean of 3.9 ± 3.6 days following surgery. PM dependency was analyzed by ECG and PM check during follow-up.
Results: Follow up was complete for all patients. One patient died early during follow-up. The mean follow-up time was 1.6 ± 2.2 years. Only 12% (n = 2) of patients were no longer pacemaker-dependent. The majority (88%, n = 15) was still pacemaker dependent with a permanent or significant intermittent need for ventricular stimulation.
Conclusion: The majority of patients that develop a significant AV conduction disorder after implantation of a sutureless aortic valve prosthesis do not recover. In case AV conduction disorder develops after sutureless AVR, we recommend early PM implantation.