Lack of Atrial Contraction as a Predictor for Permanent Pacemaker Implantation
Jongbae Son, Min soo Kim, Dong Seop Jeong, Young Tak Lee, Pyo Won Park.
Samsung Medical Center, Seoul, Korea, Republic of.
OBJECTIVE: The Lack of atrial contraction (AC) after Maze procedure is reported to cause subsequent annulus dilatation and an increase in embolic stroke. We hypothesized that the lack of AC could increase the risk of permanent pacemaker (PPM) implantation in patients undergoing the Maze and valve surgery.
METHODS: In 376 consecutive patients who had undergone the cryo-Maze and combined valve operation, recovery of AC was assessed using Doppler echocardiographic measurement of the transmitral A-wave velocity at baseline, immediate (≤2weeks), early (≤1yr; 4.6±3.8months), and late(>1yr; 3.5±1.1years) postoperative stages.
RESULTS: During the median 53 month follow-up, 10 patients (8 female, 61±13years) underwent PPM implantation; 7 for sinus node dysfunction (pause, 9.6±2.4sec), 1 for marked sinus bradycardia, and 2 for advanced/complete atrioventricular black. Median (interquartile range) time to the PPM implantation was 13.8(0.5-68.2) months. Patients with PPM implantation showed a more frequent lack of AC versus those without PPM implantation in the early stage (P=0.005). Multivariate analysis revealed that the lack of AC in the early stage was identified as an independent predictor for PPM implantation (odds ratio 5.62, 95% confidence interval 1.06 to 30.0, p=0.039).
CONCLUSIONS: The lack of AC was independently associated with subsequent risk of PPM implantation. Therefore, close follow-up might be needed when the atrial contraction is not recovered during follow-up.
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