Pacemaker implantation following tricuspid valve annuloplastyCentral MessagePerspective
Sigurdur Ragnarsson, MD, PhD,
Amar Taha, MD, PhD,
Susanne J. Nielsen, RN, PhD,
Andrea Amabile, MD,
Arnar Geirsson, MD,
Markus Krane, MD, PhD,
David Mörtsell, MD, PhD,
Johan Sjögren, MD, PhD,
Anders Jeppsson, MD, PhD,
Andreas Martinsson, MD, PhD
Affiliations
Sigurdur Ragnarsson, MD, PhD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn; Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden; Address for reprints: Sigurdur Ragnarsson, MD, PhD, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Entrégatan 7, 222 42 Lund, Sweden.
Amar Taha, MD, PhD
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Susanne J. Nielsen, RN, PhD
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Andrea Amabile, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Arnar Geirsson, MD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
Markus Krane, MD, PhD
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn; Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, Technical University of Munich, Munich, Germany
David Mörtsell, MD, PhD
Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiology, Skane University Hospital, Lund, Sweden
Johan Sjögren, MD, PhD
Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden
Anders Jeppsson, MD, PhD
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Andreas Martinsson, MD, PhD
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
Objective: Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases. Methods: By using data from multiple Swedish mandatory national registries, all patients (n = 1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30 days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression. Results: The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8 ± 10.3 years vs 67.5 ± 12.4 years, P = .012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03). Conclusions: This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30 days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.
