Permanent pacing and conduction recovery in patients undergoing cardiac surgery for active infective endocarditis in an Australian Tertiary Centre.

Abstract

Postoperative heart block is common amongst patients undergoing surgery for infective endocarditis (IE). Limited data exists allowing cardiologists to predict who will require permanent pacemaker (PPM) implantation postoperatively. We aimed to determine the rate of postoperative PPM insertion, predictors for postoperative PPM, and describe PPM utilization and rates of device related infection during follow up. A retrospective analysis was performed of 191 consecutive patients from a single institution who underwent cardiac surgery for IE between 2001 and 2017. Preoperative and operative predictors for postoperative PPM were evaluated using univariate and multivariate logistic regression. The rate of postoperative PPM implantation was 11% (17/154). The PPM group had more preoperative prolonged PR interval alone (33% vs 12%, p=0.03), coexistent prolonged PR and QRS durations (13% vs 2%, p=0.01), infection beyond the valve leaflets (82% vs 41%, p=0.001), aortic root debridement (65% vs 23%, p=<0.001), patch repair (47% vs 20%, p=0.01), postoperative prolonged PR interval (50% vs 24%, p= 0.01), and prolonged QRS duration (47% vs 15%, p= 0.001). On multivariate analysis, infection beyond the valve leaflets emerged as an independent predictor for postoperative PPM (OR 1.94, 95% CI 1.14-3.28, p=0.014). A reduction in PPM utilization was observed in 5 patients whilst 8 patients continued to show significant ventricular pacing with no underlying rhythm at 12 months. There were no device related infections. Postoperative PPM was required in 11% of patients undergoing surgery for infective endocarditis over a 16-year period. Infection beyond the valve leaflet was an independent predictor for postoperative PPM insertion. This article is protected by copyright. All rights reserved.