Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 7, Number 4, August 2016, pages 123-129

Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era

Figure 1. Indications of pacemaker. CHB: complete heart block; AF: atrial fibrillation; VR: ventricular rate; SSS: sick sinus syndrome.

Figure 2. Type of surgery in the patients with permanent pacemaker. CABG: coronary artery bypass surgery; MV: mitral valve; TV: tricuspid valve; AV: aortic valve; R: replacement; rep: repair.

**Table 1.** Preoperative Data
	PPM, no. (%)	Non-PPM, no. (%)	P value
PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; CVA: cerebrovascular accident; LV: left ventricle; EF: ejection fraction; LAD: left anterior descending artery; LCX: left circumflex; RCA: right coronary artery.
N	20	1,214
Demographic data
Age	41.6 ± 15.6	51.3 ± 16.4	0.009
Age > 65 years	2 (10%)	279 (23%)	0.170
Gender (Male)	11 (55.0%)	721 (59.4%)	0.692
Hypertension	6.0 (30%)	576 (47.4%)	0.121
Diabetes	7.0 (35%)	522 (43%)	0.473
Dyslipidemia	0.0 (0%)	333 (27.4%)	0.006
Pulmonary hypertension	12 (60%)	240 (19.8%)	0.000
Peripheral vascular disease	1.0 (5%)	25 (2.1%)	0.364
Old CVA	1.0 (5%)	42 (3.5%)	0.709
Renal impairment (creatinine > 1.5)	1.0 (5%)	116 (9.6%)	0.490
LV systolic function (LVEF)
Normal > 55%	0.0 (0%)	57 (4.7%)	0.321
Mildly impaired 45-55%	0.0 (0%)	98 (8.1%)	0.185
Moderately impaired 35-44%	4.0 (20%)	187 (15.4%)	0.573
Moderately to severely impaired 25-34%	10 (50%)	449 (37%)	0.232
Severely impaired < 25%	6.0 (30%)	419 (34.5%)	0.673
Coronary artery disease
Left main stenosis (> 50%)	0 (0%)	168 (13.8%)	0.072
Proximal LAD stenosis (> 70%)	1 (5%)	520 (42.8%)	0.001
LCX	1 (5%)	453 (37.3%)	0.003
RCA	3 (15%)	460 (37.9%)	0.036
Drugs
β-blockers	9 (45%)	543 (44.7%)	0.981
Calcium channel blockers	0 (0%)	51 (4.2%)	0.796
Digoxin	1 (5%)	47 (3.9%)	0.796
Antiarrhythmic	0 (0%)	9 (0.7%)	0.699

Table 1. Preoperative Data

PPM, no. (%)

Non-PPM, no. (%)

P value

PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; CVA: cerebrovascular accident; LV: left ventricle; EF: ejection fraction; LAD: left anterior descending artery; LCX: left circumflex; RCA: right coronary artery.

1,214

Demographic data

Age

41.6 ± 15.6

51.3 ± 16.4

0.009

Age > 65 years

2 (10%)

279 (23%)

0.170

Gender (Male)

11 (55.0%)

721 (59.4%)

0.692

Hypertension

6.0 (30%)

576 (47.4%)

0.121

Diabetes

7.0 (35%)

522 (43%)

0.473

Dyslipidemia

0.0 (0%)

333 (27.4%)

0.006

Pulmonary hypertension

12 (60%)

240 (19.8%)

0.000

Peripheral vascular disease

1.0 (5%)

25 (2.1%)

0.364

Old CVA

1.0 (5%)

42 (3.5%)

0.709

Renal impairment (creatinine > 1.5)

1.0 (5%)

116 (9.6%)

0.490

LV systolic function (LVEF)

Normal > 55%

0.0 (0%)

57 (4.7%)

0.321

Mildly impaired 45-55%

0.0 (0%)

98 (8.1%)

0.185

Moderately impaired 35-44%

4.0 (20%)

187 (15.4%)

0.573

Moderately to severely impaired 25-34%

10 (50%)

449 (37%)

0.232

Severely impaired < 25%

6.0 (30%)

419 (34.5%)

0.673

Coronary artery disease

Left main stenosis (> 50%)

0 (0%)

168 (13.8%)

0.072

Proximal LAD stenosis (> 70%)

1 (5%)

520 (42.8%)

0.001

LCX

1 (5%)

453 (37.3%)

0.003

RCA

3 (15%)

460 (37.9%)

0.036

Drugs

β-blockers

9 (45%)

543 (44.7%)

0.981

Calcium channel blockers

0 (0%)

51 (4.2%)

0.796

Digoxin

1 (5%)

47 (3.9%)

0.796

Antiarrhythmic

0 (0%)

9 (0.7%)

0.699

**Table 2.** Operative Data
	PPM	Non-PPM	P value
PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVR: mitral valve replacement/repair; AVR: aortic valve replacement/repair; TVR: tricuspid valve replacement/repair; PVR: pulmonic valve replacement/repair; BPT: cardiopulmonary bypass time; XCT: aortic cross-clamp time.
N	20	1,214
Elective	19 (95%)	1,125 (92.7%)	0.691
Emergency	1.0 (5%)	89 (7.3%)	0.691
Reoperation	12 (60%)	301 (24.9%)	0.000
CABG alone	3.0 (15%)	572 (47.2%)	0.004
Valve alone	19 (95%)	703 (58.1%)	0.001
Combined	2 (10%)	123 (10.2%)	0.478
MVR	10 (50%)	323 (26.6%)	0.001
AVR	6.0 (30%)	257 (21.2%)	0.339
TVR	7.0 (35%)	69 (5.7%)	0.000
PVR	0.0 (0%)	16 (1.3%)	0.605
BPT (min)	169.8 ± 77.2	125.3 ± 66.5	0.003
XCT (min)	125 ± 65.3	89 ± 48	0.001
XCT > 120 min	3.3 ± 2	3 ± 2	0.622
Minimum temperature (°C)	32 ± 1.7	32 ± 4.8	0.687
Cold cardioplegia	2 (10%)	196 (16.1%)	0.458

Table 2. Operative Data

PPM

Non-PPM

P value

PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; CABG: coronary artery bypass grafting; AVR: aortic valve replacement; MVR: mitral valve replacement/repair; AVR: aortic valve replacement/repair; TVR: tricuspid valve replacement/repair; PVR: pulmonic valve replacement/repair; BPT: cardiopulmonary bypass time; XCT: aortic cross-clamp time.

1,214

Elective

19 (95%)

1,125 (92.7%)

0.691

Emergency

1.0 (5%)

89 (7.3%)

0.691

Reoperation

12 (60%)

301 (24.9%)

0.000

CABG alone

3.0 (15%)

572 (47.2%)

0.004

Valve alone

19 (95%)

703 (58.1%)

0.001

Combined

2 (10%)

123 (10.2%)

0.478

MVR

10 (50%)

323 (26.6%)

0.001

AVR

6.0 (30%)

257 (21.2%)

0.339

TVR

7.0 (35%)

69 (5.7%)

0.000

PVR

0.0 (0%)

16 (1.3%)

0.605

BPT (min)

169.8 ± 77.2

125.3 ± 66.5

0.003

XCT (min)

125 ± 65.3

89 ± 48

0.001

XCT > 120 min

3.3 ± 2

3 ± 2

0.622

Minimum temperature (°C)

32 ± 1.7

32 ± 4.8

0.687

Cold cardioplegia

2 (10%)

196 (16.1%)

0.458

**Table 3.** Preoperative Electrocardiogram (ECG)
	PPM, no. (%)	Non-PPM, no (%)	P value
PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; AF: atrial fibrillation; BBB: bundle branch block; LBBB: left bundle branch block; RBBB: right bundle branch block; AVB: atrioventricular block.
N	20	1,214
AFIB	5 (25%)	179 (14.7%)	0.202
Any BBB	3 (15%)	91 (7.5%)	0.213
LBBB	2 (10%)	28 (2.3%)	0.027
RBBB	2 (10%)	64 (5.3%)	0.351
First-degree AVB	4 (20%)	66 (5.4%)	0.005

Table 3. Preoperative Electrocardiogram (ECG)

PPM, no. (%)

Non-PPM, no (%)

P value

PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; AF: atrial fibrillation; BBB: bundle branch block; LBBB: left bundle branch block; RBBB: right bundle branch block; AVB: atrioventricular block.

1,214

AFIB

5 (25%)

179 (14.7%)

0.202

Any BBB

3 (15%)

91 (7.5%)

0.213

LBBB

2 (10%)

28 (2.3%)

0.027

RBBB

2 (10%)

64 (5.3%)

0.351

First-degree AVB

4 (20%)

66 (5.4%)

0.005

**Table 4.** Postoperative Data
	PPM, no (%)	Non-PPM, no (%)	P value
PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; MI: myocardial infarction; Trop-T: troponin-T; ICU: intensive care unit.
N	20	1,214
Perioperative MI	0.0 (0%)	267 (22%)	0.018
Elevated Trop-T (> 0.01)	8.0 (40%)	689 (56.8%)	0.134
ICU stay (days)	6.80 ± 6.0	9 ± 4.74	0.311
Hospital stay (days)	18.1 ± 11.5	12.3 ± 8.5	0.000
Mortality	0 (0.0%)	92 (7.6%)	0.201

Table 4. Postoperative Data

PPM, no (%)

Non-PPM, no (%)

P value

PPM: permanent pacemaker; non-PPM: non-permanent pacemaker; MI: myocardial infarction; Trop-T: troponin-T; ICU: intensive care unit.

1,214

Perioperative MI

0.0 (0%)

267 (22%)

0.018

Elevated Trop-T (> 0.01)

8.0 (40%)

689 (56.8%)

0.134

ICU stay (days)

6.80 ± 6.0

9 ± 4.74

0.311

Hospital stay (days)

18.1 ± 11.5

12.3 ± 8.5

0.000

Mortality

0 (0.0%)

92 (7.6%)

0.201

**Table 5.** Predictors of Permanent Pacemaker Implantation
Variables	P value	OR	95% confidence interval of the difference
LBB: left buddle branch block; P-HTN: pulmonary hypertension.
LBBB	0.042	2.0	1.32	5.54
P-HTN	0.001	5.08	1.941	13.296
Reoperation	0.001	4.515	1.828	11.15

Table 5. Predictors of Permanent Pacemaker Implantation

Variables

P value

95% confidence interval of the difference

Lower

Upper

LBB: left buddle branch block; P-HTN: pulmonary hypertension.

LBBB

0.042

2.0

1.32

5.54

P-HTN

0.001

5.08

1.941

13.296

Reoperation

0.001

4.515

1.828

11.15