@article{b3a59a443442467e8a98c538c4c751b8,
title = "Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation",
abstract = "Background: The incidence of permanent pacemaker (PPM)implantation is higher following mitral valve surgery (MVS)with ablation for atrial fibrillation (AF)compared with MVS alone. Objectives: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS. Methods: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117)or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI)(n = 62)or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality. Results: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%)underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA)functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation)and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05)after adjustment for randomization assignment, age, and NYHA functional class. Conclusions: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality.",
keywords = "biatrial maze, cardiac surgery, permanent pacemaker, pulmonary vein isolation, valvular heart disease",
author = "{CTSN Investigators} and DeRose, {Joseph J.} and Mancini, {Donna M.} and Chang, {Helena L.} and Michael Argenziano and Fran{\c c}ois Dagenais and Gorav Ailawadi and Perrault, {Louis P.} and Parides, {Michael K.} and Taddei-Peters, {Wendy C.} and Mack, {Michael J.} and Glower, {Donald D.} and Yerokun, {Babatunde A.} and Pavan Atluri and Mullen, {John C.} and Puskas, {John D.} and Karen O'Sullivan and Sledz, {Nancy M.} and Hugo Tremblay and Ellen Moquete and Ferket, {Bart S.} and Moskowitz, {Alan J.} and Alexander Iribarne and Gelijns, {Annetine C.} and O'Gara, {Patrick T.} and Blackstone, {Eugene H.} and Gillinov, {A. Marc} and Miller, {Marissa A.} and Dennis Buxton and Amy Connolly and Geller, {Nancy L.} and David Gordon and Jeffries, {Neal O.} and Albert Lee and Moy, {Claudia S.} and Gombos, {Ilana Kogan} and Jennifer Ralph and Richard Weisel and Gardner, {Timothy J.} and Rose, {Eric A.} and Ascheim, {Deborah D.} and Emilia Bagiella and Helena Chang and Melissa Chase and Edlira Dobrev and Seth Goldfarb and Lopa Gupta and Katherine Kirkwood and Ron Levitan and Jessica Overbey and Milerva Santos",
note = "Funding Information: The AF ablation trial was supported by a cooperative agreement (U01 HL088942)funded by the National Heart, Lung, and Blood Institute, the National Institutes of Neurological Disorders and Stroke of the National Institutes of Health (NIH)and the Canadian Institutes for Health Research (CIHR). The views expressed in this paper are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or the United States Department of Health and Human Services. This trial was designed to evaluate ablation as a therapeutic approach, not to support FDA-approval for any individual device. Dr. Mack has been a principal investigator for Edwards Lifesciences and Abbott Vascular; and has been an Executive Board member for Medtronic. Dr. Gillinov has been a consultant for Edwards Lifesciences, Medtronic, AtriCure, Abbott, CryolLife, and ClearFlow; has received royalties and equity rights from ClearFlow; and has received institutional royalties from AtriCure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper. Fred Morady, MD, served as Guest Associate Editor for this paper. Publisher Copyright: {\textcopyright} 2019 American College of Cardiology Foundation",
year = "2019",
month = may,
day = "21",
doi = "10.1016/j.jacc.2019.02.062",
language = "English (US)",
volume = "73",
pages = "2427--2435",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "19",
}