Long-Term Atrioventricular Block Following Valve Surgery: Electrocardiographic and Surgical Predictors
Jacopo FarinaMauro BiffiGianluca FolesaniLuca Di MarcoSofía Sol MartínCorrado ZenesiniCarlo SaviniMatteo ZiacchiIgor DiembergerCristian MartignaniDavide Pacini
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Abstract:
Background: Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. Methods: We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010. Results: During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2–3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9–12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4–10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8–8.3, p < 0.001). Conclusion: Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation.Keywords:
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Bundle branch block
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Blockages in any of the three intraventricular conduction pathways (the right bundle branch, and anterior superior radiations and posterior inferior radiations of the left bundle branch) have specific effects on the QRS pattern as seen on the standard electrocardiogram. The presence of block in two of the three pathways (manifested by right bundle branch block and left axis deviation, right bundle branch block and right axis deviation, alternating complete right and left bundle branch block, or to a lesser extent left bundle branch block) has been found in many patients with documented intermittent heart block or in patients who subsequently develop permanent complete heart block. The presence of this QRS pattern in patients with histories of syncope or dizziness suggests that their symptoms may be due to intermittent heart block. Such patients should be monitored to document heart block, or should have permanent demand pacemakers implanted, or both.
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Blockages in any of the three intraventricular conduction pathways (the right bundle branch, and anterior superior radiations and posterior inferior radiations of the left bundle branch) have specific effects on the QRS pattern as seen on the standard electrocardiogram. The presence of block in two of the three pathways (manifested by right bundle branch block and left axis deviation, right bundle branch block and right axis deviation, alternating complete right and left bundle branch block, or to a lesser extent left bundle branch block) has been found in many patients with documented intermittent heart block or in patients who subsequently develop permanent complete heart block. The presence of this QRS pattern in patients with histories of syncope or dizziness suggests that their symptoms may be due to intermittent heart block. Such patients should be monitored to document heart block, or should have permanent demand pacemakers implanted, or both.
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