心脏手术后心脏起搏器植入：当代全国视角。

IF 5.1 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Pub Date : 2025-03-29 DOI:10.1136/heartjnl-2024-325321

Amar Taha, Alice David, Sigurdur Ragnarsson, Piotr Szamlewski, Shabbar Jamaly, Jan Gustav Smith, Susanne J Nielsen, Anders Jeppsson, Andreas Martinsson

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Patients with previous PPM, previous or later implantable cardioverter-defibrillator (ICD) and those who underwent heart transplantation were excluded.Results: Overall, 76 447 patients were included, out of which 8.2% (n=6271) received a PPM. The cumulative incidence of PPM implantation was 2.9%, 3.8% and 9.5% at 30 days, 1 year and 10 years following cardiac surgery, respectively. The main PPM indication was atrioventricular block. Tricuspid valve surgery exhibited the highest cumulative incidence for PPM both at 30 days (6.8%, 95% CI 4.3% to 10.0%) and 1 year (8.8%, 95% CI 6.0% to 12.0%) surpassing mitral valve surgery (30 day 5.3%, 95% CI 4.7% to 6.0%; 1 year 6.5%, 95% CI 5.8% to 7.3%), aortic valve surgery (30 day 4.8%, 95% CI 4.5% to 5.1%; 1 year 6.0%, 95% CI 5.6% to 6.3%) and CABG (30 day 0.74%, 95% CI 0.6% to 0.8%; 1 year 1.3%, 95% CI 1.2% to 1.3%). 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引用次数: 0

摘要

背景：心脏手术会增加发生缓慢性心律失常的风险，但目前对永久起搏器（PPM）植入的估计依赖于非现代研究。本研究的主要目的是在现代队列中探讨不同心脏外科手术后 30 天和 1 年的 PPM 植入发生率和适应症。次要结果是 10 年后的 PPM 发生率以及从心脏手术到 PPM 植入的时间：这项基于全国人口的研究纳入了 2006 年至 2020 年期间瑞典首次接受冠状动脉旁路移植术 (CABG) 和/或瓣膜手术的所有患者。既往接受过 PPM、既往或后来接受过植入式心律转复除颤器 (ICD) 的患者以及接受过心脏移植的患者均被排除在外：总共纳入了 76 447 名患者，其中 8.2% 的患者（n=6271）接受了 PPM。心脏手术后30天、1年和10年的PPM植入累积发生率分别为2.9%、3.8%和9.5%。PPM 的主要适应症是房室传导阻滞。三尖瓣手术后 30 天（6.8%，95% CI 4.3% 至 10.0%）和 1 年（8.8%，95% CI 6.0% 至 12.0%）的 PPM 累计发生率最高，超过二尖瓣手术（30 天 5.3%，95% CI 4.7% 至 6.0%；1 年为 6.5%，95% CI 为 5.8% 至 7.3%）、主动脉瓣手术（30 天为 4.8%，95% CI 为 4.5% 至 5.1%；1 年为 6.0%，95% CI 为 5.6% 至 6.3%）和 CABG（30 天为 0.74%，95% CI 为 0.6% 至 0.8%；1 年为 1.3%，95% CI 为 1.2% 至 1.3%）。联合手术（多瓣膜和/或 CABG）后，30 天和 1 年的发病率分别为 6.5%（95% CI 6.0% 至 6.9%）和 8.1%（95% CI 7.7% 至 8.6%）。同时进行消融手术会进一步增加风险（调整后 HR 为 9.2，95% CI 为 7.9 至 10.6；P 结论：心脏手术后需要大量的PPM，主要是由于房室传导阻滞。三尖瓣手术是单独手术中发生 PPM 风险最高的手术。联合手术和同时进行的手术消融进一步增加了这一风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Pacemaker implantation after cardiac surgery: a contemporary, nationwide perspective.

Background: Cardiac surgery carries a heightened risk of bradyarrhythmias, but current permanent pacemaker (PPM) implantation estimates rely on non-contemporary studies. This study primarily aimed to explore the incidence and indications for PPM implantation at 30 days and 1 year after different cardiac surgical procedures in a modern cohort. Secondary outcomes were PPM incidence at 10 years and time from cardiac surgery to PPM implantation.

Methods: This nationwide population-based study included all patients in Sweden who from 2006 to 2020 underwent first-time coronary artery bypass grafting (CABG) and/or valvular surgery. Patients with previous PPM, previous or later implantable cardioverter-defibrillator (ICD) and those who underwent heart transplantation were excluded.

Results: Overall, 76 447 patients were included, out of which 8.2% (n=6271) received a PPM. The cumulative incidence of PPM implantation was 2.9%, 3.8% and 9.5% at 30 days, 1 year and 10 years following cardiac surgery, respectively. The main PPM indication was atrioventricular block. Tricuspid valve surgery exhibited the highest cumulative incidence for PPM both at 30 days (6.8%, 95% CI 4.3% to 10.0%) and 1 year (8.8%, 95% CI 6.0% to 12.0%) surpassing mitral valve surgery (30 day 5.3%, 95% CI 4.7% to 6.0%; 1 year 6.5%, 95% CI 5.8% to 7.3%), aortic valve surgery (30 day 4.8%, 95% CI 4.5% to 5.1%; 1 year 6.0%, 95% CI 5.6% to 6.3%) and CABG (30 day 0.74%, 95% CI 0.6% to 0.8%; 1 year 1.3%, 95% CI 1.2% to 1.3%). The incidence following combined operations (multiple valves and/or CABG) was 6.5% (95% CI 6.0% to 6.9%) and 8.1% (95% CI 7.7% to 8.6%) at 30 days and 1 year, respectively. Concomitant ablation surgery increased the risk even further (adjusted HR 9.2, 95% CI 7.9 to 10.6; p<0.001).

Conclusions: The need for PPM after cardiac surgery is substantial, primarily due to atrioventricular block. Tricuspid valve surgery is associated with the highest risk for PPM among isolated procedures. Combined procedures and concomitant surgical ablation further increase that risk.

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来源期刊

Heart 医学-心血管系统

CiteScore

10.30

自引率

5.30%

发文量

320

审稿时长

3-6 weeks

期刊介绍： Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.