HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Vibeke Hjortdal Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Smerup, M. Articles by Hjortdal, V. Search for Related Content PubMed PubMed Citation Articles by Smerup, M. Articles by Hjortdal, V. Related Collections Cardiac - other Congenital - acyanotic Electrophysiology - arrhythmias

Eur J Cardiothorac Surg 2005;28:61-68
© 2005 Elsevier Science NL

Pacemaker implantation after congenital heart surgery: risk and prognosis in a population-based follow-up study

^a Department of Cardiothoracic & Vascular Surgery T, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, 8200 Aarhus N, Denmark
^b Department of Clinical Epidemiology, Faculty of Health Sciences, Aarhus University, 8000 Aarhus C, Denmark
^c Department of Cardiology B, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, 8200 Aarhus N, Denmark

Received 19 December 2004; received in revised form 4 March 2005; accepted 4 April 2005.

^* Corresponding author. Address: Department of Cardiothoracic & Vascular Surgery T, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, 8200 Aarhus N, Denmark. Tel.: +45 89495483; fax: +45 89496016. (Email: morten.smerup{at}ki.au.dk).

Objective: Although earlier a feared complication of congenital cardiac surgery, the incidence of heart-block and sinus node dysfunction has been lowered to 1–4% due to improved surgical techniques and better anatomical understanding of the cardiac conduction system. Development of feasible pacemaker technologies has further lowered mortality and morbidity. However, pacemaker implantation in paediatric patients is in itself associated with significant morbidity due to pacemaker system failure and replacement. The aim of the present study was to examine prognostic factors of mortality, failure of systems and timing of implantation after surgery in post-surgical pacemaker patients. Methods: We carried out a historical prospective follow-up analysis of all patients (age less than 18 years) who underwent pacemaker implantation due to post-surgical heart-block or sinus node dysfunction in the period 1981–2002 at our institution. Data was extracted from the Danish Pacemaker Register and hospital records. Kaplan–Meier survival time estimates and Cox proportional hazards analysis (Relative Risk, RR) were used to identify prognostic factors. Results: High RACHS score (RR, 16.57), low age at implantation (RR, 0.22), low age at operation (RR, 0.06) and epicardial lead (RR, 0.18) were significant predictors for early mortality. Similarly, high RACHS score (RR, 4.84), low age at implantation (RR, 0.32), low age operation (RR, 0.38) and epicardial lead (RR, 0.40) were significant predictors failure of 1st pacemaker system. Conclusions: We identified a number of prognostic factors of patient mortality and failure of systems. One factor, high RACHS score, was previously shown to predict mortality and length of ICU stay in paediatric cardiac surgery; however, this study is the first to show a correlation between RACHS score and mortality as well as failure of pacemaker systems. This may have future implications for preoperative risk stratification of patients and counselling of parents to patients with congenital heart disease.

Key Words: Pacemaker • Cardiac surgical procedures • Heart block • Mortality

This article has been cited by other articles:

				H. Olgun, T. Karagoz, A. Celiker, and N. Ceviz Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker Europace, July 1, 2008; 10(7): 844 - 847. [Abstract] [Full Text] [PDF]

				P.A. Zartner, R.P. Handke, A.M. Brecher, and M.B.E. Schneider Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl Europace, March 1, 2007; 9(3): 192 - 193. [Abstract] [Full Text] [PDF]