BACKGROUND: Permanent pacemaker (PPM) implantation is required in 3-8% of all patients undergoing aortic valve replacement (AVR). Our aim was to evaluate the contemporary incidence and risk factors for permanent pacemaker implantation after isolated aortic valve replacement.
METHODS: Since June 2004, during 9-year period, a total of 875 consecutive patients underwent isolated AVR at our institution. Of these, 23 patients developed significant conduction disorders leading to PPM implantation postoperatively.
RESULTS: Twenty three patients (2.63%, median age 71 (57-89) years) had irreversible second or third degree atrioventricular (AV) block requiring permanent pacing. Preoperative ECG showed normal sinus rhythm (n = 10), first degree AV block (n = 4), left bundle branch block (n = 3), right bundle branch block (n = 3) and atrial fibrillation (n=3). Pacemakers were implanted after a median of 7 (3-116) days following AVR. Risk factors for permanent pacing identified by univariate analysis were: preoperative myocardial infarction, pulmonary hypertension, anaemia, age older than 75 years and use of β-blockers. Multivariate logistic regression analysis identified preoperative myocardial infarction (p < 0.0005; OR 15.2, 95% CI 6.3 to 19.9) and pulmonary hypertension (p < 0.005; OR 12.5, 95% CI 3.2 to 18.3).
CONCLUSIONS: Irreversible AV block requiring permanent pacemaker implantation is a relatively rare complication following isolated aortic valve replacement. Previous myocardial infarction and pulmonary hypertension should be considered in order to identify patients at increased risk for advanced AV block.
