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Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience

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Abstract

This was a retrospective study documenting all pacemaker implantations (PMIs) secondary to postoperative atrioventricular block. A total of 26 patients were included between 2011 and 2020. The incidence rate was 1.8%, with a median follow-up time of 4.5 years. At the time of the initial PMI, the median weight was 5 kg, and the median generator longevity was 45 months. Mean cardiopulmonary bypass and aortic clamp times were significantly longer among surgeries complicated with PMI (P≤ 0.05). Trisomy 21 patients were 4 times more likely to need a PMI (95% CI 1.8–9, P < 0.001). The mean Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgery scores were higher in patients with PMI. All initial PMIs were epicardial (18 single chamber). Most patients underwent ventricular septal defect closure (isolated or complex), except for 5 patients who underwent left-sided surgery. Pacing-induced dilated cardiomyopathy occurred in 3 patients. All implanted leads were functional except for 2 leads with high thresholds and another biventricular system infection. There was a 31% rate of pacing reintervention.

Conclusion: PMI resulted in significant morbidity but without mortality. The highest risk for PMI was left ventricular outflow tract repair, trisomy 21, prolonged cardiopulmonary bypass, and aortic cross times.

What is Known:

•Incidence rate for postoperative atrioventricular block requiring pacemaker was at 1.8%, similar to previously published reports.

•Longer cardiopulmonary bypass and aortic cross-clamp times were associated with higher risk for developing postoperative persistent atrioventricular block.

What is New:

•Incidence for persistent atrioventricular block requiring pacemaker was highest among left ventricular outflow tract surgery at 8.6%.

•Following all intracardiac repair, Down syndrome patients were 4 times more likely to need a pacemaker implantation compared to the non-syndromic group.

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Abbreviations

ACC:

Aortic cross-clamp

ASD:

Atrial septal defect

AVB:

Atrioventricular block

AVSD:

Atrioventricular Septal Defect

CDH:

Chest Disease Hospital

CHD:

Congenital Heart Disease

CPB:

Cardiopulmonary Bypass

CRTP:

Cardiac Resynchronization Therapy Pacemaker

DCM:

Dilated Cardiomyopathy

DORV:

Double Outlet Right Ventricle

d-TGA:

D-Transposition of Great Arteries

LAI:

Left Atrial Isomerism

LAVV:

Left Atrioventricular Valve

l-TGA:

L-Malposed Great Arteries

LVOT:

Left Ventricular Outflow Tract

m:

Months

PG:

Pacemaker Generator

PMI:

Pacemaker Implantation

POD:

Postoperative Day

RACHS:

Risk Adjustment in Congenital Heart Surgery

RV:

Right Ventricle

STS:

Society of Thoracic Surgery

TOF:

Tetralogy of Fallot

TV:

Tricuspid Valve

VSD:

Ventricular Septal Defect

wk:

Week

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, affiliated with Chest Diseases Hospital, Kuwait University, Block 4, Street 102, Postal Office 46300, Jabriya, Kuwait

    Mohammad A. Ebrahim

  2. Faculty of Medicine, Kuwait University, Jabriya, Kuwait

    Hasan Kh. Ashkanani, Reem S. Alramzi & Zaina I. Malhas

  3. Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Jabriya, Kuwait

    Mariam Al-Bahrani

  4. Division of Health and Vital Statistics, National Center for Health Information at Ministry of Health, Kuwait City, Kuwait

    Ali A. Sadek

  5. Department of Pediatric Cardiac Surgery, Ministry of Health, Chest Diseases Hospital, Kuwait City, Kuwait

    Moustafa A. Elsayed & Vadim G. Lyubomudrov

Authors
  1. Mohammad A. Ebrahim
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  2. Hasan Kh. Ashkanani
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  7. Moustafa A. Elsayed
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  8. Vadim G. Lyubomudrov
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Contributions

MAE, conceptualization, methodology, ethics paperwork, article drafting, revision, concept, and design; (2) HKA, ethics paperwork, literature search, and data collection; (3) RSA, ethics paperwork and data collection; (4) ZLM, ethics paperwork and data collection; (5) MAB, statistical analysis; (6) AAS, statistical analysis; (7) MAE, critical revision of article; and (8) VGL, critical revision of article.

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Correspondence to Mohammad A. Ebrahim.

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Communicated by Peter de Winter

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Ebrahim, M.A., Ashkanani, H.K., Alramzi, R.S. et al. Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience. Eur J Pediatr 179, 1867–1872 (2020). https://doi.org/10.1007/s00431-020-03739-9

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  • DOI: https://doi.org/10.1007/s00431-020-03739-9

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