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Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence.

Steyers CM, Khera R, Bhave P - PLoS ONE (2015)

Bottom Line: A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint.There were 10 unique studies with a total of 780 patients.Mean follow-up ranged from 6-72 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.

ABSTRACT

Background: Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population.

Methods: We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria.

Results: A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6-72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies.

Conclusions: Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus

Flowsheet for selection of included studies (PRISMA).
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pone.0140340.g001: Flowsheet for selection of included studies (PRISMA).

Mentions: A total of ten studies met the pre-specified inclusion and exclusion criteria and were selected for inclusion in the systematic review (Fig 1). Eight studies specifically addressed the ‘pacemaker dependency’ endpoint and were included in Table 1. Three studies addressed the ‘recovery of native conduction’ endpoint and were included in Table 2. One study documented both endpoints and was included in both tables. All studies are presented chronologically. The references were managed using the Endnote X7 for Mac (Thomson Reuters). Study quality for each of the included studies was assessed using the ‘Good ReseArch for Comparative Effectiveness (GRACE) checklist and is provided as S1 Table [6].


Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence.

Steyers CM, Khera R, Bhave P - PLoS ONE (2015)

Flowsheet for selection of included studies (PRISMA).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4607414&req=5

pone.0140340.g001: Flowsheet for selection of included studies (PRISMA).
Mentions: A total of ten studies met the pre-specified inclusion and exclusion criteria and were selected for inclusion in the systematic review (Fig 1). Eight studies specifically addressed the ‘pacemaker dependency’ endpoint and were included in Table 1. Three studies addressed the ‘recovery of native conduction’ endpoint and were included in Table 2. One study documented both endpoints and was included in both tables. All studies are presented chronologically. The references were managed using the Endnote X7 for Mac (Thomson Reuters). Study quality for each of the included studies was assessed using the ‘Good ReseArch for Comparative Effectiveness (GRACE) checklist and is provided as S1 Table [6].

Bottom Line: A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint.There were 10 unique studies with a total of 780 patients.Mean follow-up ranged from 6-72 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.

ABSTRACT

Background: Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population.

Methods: We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria.

Results: A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6-72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies.

Conclusions: Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.

No MeSH data available.


Related in: MedlinePlus