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 http://www.cardiologyres.org

Short Communication

Volume 11, Number 1, February 2020, pages 56-60


Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease

Tables

Table 1. Characteristic of Patients With Carcinoid Heart Disease Who Underwent a Valve Replacement Surgery According to Post-Surgical Permanent Pacemaker Placement
 
Overall (n = 19)Post-surgical PPM placement
PPM (n = 6)No PPM (n = 13)P valuea
Values are number (%) or mean ± standard deviation. aFisher’s exact test or t-test. bAverage age in years at time of surgery or during last visit. cDiagnosed via left heart catheterization. dBody mass index ≥ 30 kg/m2. AVB: atrioventricular block; AVR: aortic valve replacement; EKG: electrocardiogram; LVEF: left ventricular ejection fraction; ms: millisecond; NYHA: New York Heart Association; PPM: permanent pacemaker; PVR: pulmonary valve replacement; RBBB: right bundle branch block; RV: right ventricle; RVSP: right ventricular systolic pressure; TTE: transthoracic echocardiogram; TVR: tricuspid valve replacement.
Demographic and comorbidity profile
  Ageb, years60.4 ± 1.963.2 ± 1.959.2 ± 2.60.331
  Male11 (57.9)1 (16.7)10 (76.9)0.041
  Hypertension12 (63.2)1 (16.7)11 (84.6)0.010
  Diabetes mellitus3 (15.8)1 (16.7)2 (15.4)1.000
  Hyperlipidemia4 (21.1)1 (16.7)3 (23.1)1.000
  Coronary artery diseasec2 (10.5)1 (16.7)1 (7.7)1.000
  Atrial fibrillation7 (36.9)4 (66.7)3 (23.1)0.129
  Obesityd4 (21.1)0 (0.0)4 (33.8)0.255
  NYHA class III/IV19 (100)6 (100)13 (100)-
Prior treatment
  Prior valve surgery2 (10.5)1 (16.7)1 (7.7)1.000
  Prior octreotide treatment19 (100)6 (100)13 (100)-
Pre-surgical EKG parameters
  First degree AVB3 (15.8)0 (0.0)3 (23.1)0.522
  ≥ Second degree AVB0 (0)0 (0)0 (0)-
  RBBB3 (15.8)0 (0.0)3 (23.1)0.517
  Left fascicular block2 (10.5)1 (16.7)1 (7.7)1.000
  PR interval (ms)167.6 ± 13.0158.8 ± 9.8171.6 ± 18.60.660
  QRS interval (ms)102.3 ± 4.0104.2 ± 10.7101.5 ± 3.70.765
Pre-surgical TTE parameters
  LVEF (%)54.6 ± 1.256.8 ± 1.953.5 ± 1.50.236
  Reduced RV function15 (79.0)4 (66.7)11 (84.6)0.557
  RVSP (mm Hg)32.0 ± 3.035.0 ± 9.130.9 ± 2.80.566
  Pulmonary insufficiency, moderate to severe12 (63.2)2 (33.3)10 (76.9)0.129
  Pulmonary stenosis11 (58.9)3 (50.0)8 (61.5)1.000
  Tricuspid regurgitation, moderate to severe18 (94.7)6 (100.0)12 (92.3)1.000
  Tricuspid stenosis6 (31.6)1 (16.7)5 (38.5)0.605
Post-surgical TTE parametersa
  LVEF (%)55.6 ± 2.255.8 ± 4.055.5 ± 2.80.945
  Reduced RV function7 (43.8)3 (50.0)4 (40.0)1.000
  RVSP (mm Hg)30.3 ± 2.536.0 ± 5.128.0 ± 2.70.161
Type of surgery0.088
  PVR1 (6.3)0 (0.0)1 (7.7)
  PVR + TVR16 (84.2)4 (66.7)12 (92.3)
  PVR + TVR + AVR2 (10.5)2 (33.3)0 (0.0)
Post-surgical mortality2 (10.5)1 (16.7)1 (7.7)1.000
  Operative (30 days)0 (0.0)0 (0.0)0 (0.0)-
  During 6-months follow up2 (10.5)1 (16.7)1 (7.7)1.000

 

Table 2. Characteristics of Patients With Carcinoid Heart Disease Who Required Post-Surgical Pacemaker Placement
 
PatientSurgeryYear of surgeryPrior valve surgeryReason for PPMTime to PPM (days)PPM typePPM burden in several months
AVR: aortic valve replacement; CHB: complete heart block; NA: not available; PPM: permanent pacemaker: PVR: pulmonary valve replacement; TVR: tricuspid valve replacement; A: atrial; V: ventricular.
1TVR, PVR2012Yes (TVR, PVR)CHB6Dual-chamber100% V-paced
2TVR, PVR, AVR2014NoneCHB8Dual-chamberNA
3TVR, PVR2015NoneCHB7Dual-chamber33% A-paced
4TVR, PVR2015NoneCHB7Dual-chamber19% A-paced, 100% V-paced
5TVR, PVR2004NoneCHB5Dual-chamber100% V-paced
6TVR, PVR, AVR2012NoneCHB5Dual-chamber87% A-paced, 11% V-paced