Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation

CTSN Investigators

Research output: Contribution to journalArticle

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. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370)

Original languageEnglish (US)
Pages (from-to)2427-2435
Number of pages9
JournalJournal of the American College of Cardiology
Volume73
Issue number19
DOIs
StatePublished - May 21 2019

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Mitral Valve
Atrial Fibrillation
Pulmonary Veins
Confidence Intervals
Random Allocation
Mortality
Length of Stay
Hospitalization

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation. / CTSN Investigators.

In: Journal of the American College of Cardiology, Vol. 73, No. 19, 21.05.2019, p. 2427-2435.

Research output: Contribution to journalArticle

@article{d451789dba9f48418bcd54ed2784a830,
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. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370)",
author = "{CTSN Investigators} and DeRose, {Joseph J.} and Mancini, {Donna M.} and Chang, {Helena L.} and Michael Argenziano and Fran{\cc}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 {Sai Sudhakar}, Chittoor",
year = "2019",
month = "5",
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",
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TY - JOUR

T1 - Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation

AU - CTSN Investigators

AU - DeRose, Joseph J.

AU - Mancini, Donna M.

AU - Chang, Helena L.

AU - Argenziano, Michael

AU - Dagenais, François

AU - Ailawadi, Gorav

AU - Perrault, Louis P.

AU - Parides, Michael K.

AU - Taddei-Peters, Wendy C.

AU - Mack, Michael J.

AU - Glower, Donald D.

AU - Yerokun, Babatunde A.

AU - Atluri, Pavan

AU - Mullen, John C.

AU - Puskas, John D.

AU - O'Sullivan, Karen

AU - Sledz, Nancy M.

AU - Tremblay, Hugo

AU - Moquete, Ellen

AU - Ferket, Bart S.

AU - Moskowitz, Alan J.

AU - Iribarne, Alexander

AU - Gelijns, Annetine C.

AU - O'Gara, Patrick T.

AU - Blackstone, Eugene H.

AU - Gillinov, A. Marc

AU - Miller, Marissa A.

AU - Buxton, Dennis

AU - Connolly, Amy

AU - Geller, Nancy L.

AU - Gordon, David

AU - Jeffries, Neal O.

AU - Lee, Albert

AU - Moy, Claudia S.

AU - Gombos, Ilana Kogan

AU - Ralph, Jennifer

AU - Weisel, Richard

AU - Gardner, Timothy J.

AU - Rose, Eric A.

AU - Ascheim, Deborah D.

AU - Bagiella, Emilia

AU - Chang, Helena

AU - Chase, Melissa

AU - Dobrev, Edlira

AU - Goldfarb, Seth

AU - Gupta, Lopa

AU - Kirkwood, Katherine

AU - Levitan, Ron

AU - Overbey, Jessica

AU - Sai Sudhakar, Chittoor

PY - 2019/5/21

Y1 - 2019/5/21

N2 - 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. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370)

AB - 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. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370)

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U2 - 10.1016/j.jacc.2019.02.062

DO - 10.1016/j.jacc.2019.02.062

M3 - Article

VL - 73

SP - 2427

EP - 2435

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 19

ER -