TOPLINE

Patients implanted with a permanent pacemaker after cardiac surgery had increased risks for death and hospitalization for heart failure. Implantation of implantable cardioverter defibrillators (ICDs) was associated with increased risks for heart failure admissions and cardiovascular deaths.

METHODOLOGY

• Researchers conducted an observational study to examine the long-term outcomes of implanting a permanent pacemaker or ICD shortly after cardiac surgery.
• They used Swedish registries and included 76,223 adults who underwent cardiac surgery between 2006 and 2020. The mean age of patients was 67.8 years, and 75% were men.
• Researchers identified patients who had permanent pacemakers or ICDs implanted within 30 days after surgery.
• The primary objective was assessment of all-cause mortality. Secondary outcomes included risks for cardiovascular mortality and hospitalizations for heart failure.
• The mean follow-up duration was 6.8 years.

TAKEAWAY

• Overall, 2.8% of patients received a permanent pacemaker and 0.5% received an ICD within 30 days after surgery.
• Recipients of pacemakers had higher risks for all-cause mortality (adjusted hazard ratio [aHR], 1.09; P = .048) and hospitalization for heart failure (aHR, 1.36; P < .001) than nonrecipients. They showed a similar but statistically nonsignificant trend for cardiovascular mortality.
• ICD implantation was not associated with an increased risk for all-cause mortality but was linked to increased risks for hospitalization for heart failure (aHR, 2.07; P < .001) and cardiovascular mortality (aHR, 1.30; P = .043).

IN PRACTICE

"While pacemaker implantation is often unavoidable and lifesaving, recognition of its association with long-term morbidity should prompt consideration of pacing strategies that minimise ventricular dyssynchrony, as well as early identification and management of pacing-related heart failure," the researchers wrote.

SOURCE

The study was led by Laura Alice David of University of Gothenburg, Gothenburg, Sweden. It was published online on September 21 in Heart.

LIMITATIONS

The study was observational and could not prove that implantation of pacemakers caused death. Researchers excluded patients who died within first 30 days after surgery, which may have introduced survivor bias. They lacked information on conduction issues, pacing burden, position of lead, or device settings.

DISCLOSURES

The study received funding from the Swedish state through its agreement with regional health authorities for medical research and training and from the Swedish Heart‑Lung Foundation. One author reported receiving speaker fees and consultancy payments from companies unrelated to this study. Another author reported receiving unrelated financial reimbursement from commercial entities. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.