Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery

Joseph Kassab, Serge C. Harb, Milind Y. Desai, A. Marc Gillinov, Habib Layoun, Joseph El Dahdah, Michel Chedid El Helou, Shady Nakhla, Haytham Elgharably, Samir R. Kapadia, Paul C. Cremer, Amgad Mentias*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. METHODS AND RESULTS: Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all-cause mortality and readmission with endocarditis or heart failure on follow-up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17–1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02–1.23], P=0.02), preoperative second-degree heart block (RR, 2.20 [95% CI, 1.81–2.69], P<0.0001), right bundle-branch block (RR, 1.21 [95% CI, 1.03–1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06–1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01–1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16–4.75], P<0.0001). After a median follow-up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93–1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14–1.43], P<0.001). CONCLUSIONS: PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization.

Original languageEnglish (US)
Article numbere032760
JournalJournal of the American Heart Association
Issue number3
StatePublished - Feb 6 2024


  • all-cause mortality
  • heart failure
  • incidence
  • permanent pacemaker
  • risk factor
  • tricuspid valve surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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