View More View Less
  • 1 Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Zrínyi M. út 1., 8900
  • 2 Zala Megyei Szent Rafael Kórház, Zalaegerszeg
Open access

Absztrakt:

A szívműtét utáni pacemaker-terápiát igénylő ritmuszavarok kérdésköre jól ismert és tanulmányozott, problematikája komoly kihívások elé állítja a szakmát. Írásunk célja összefoglalni a jelenleg érvényes nemzetközi ajánlásokat és a jelentős tanulmányok eredményeit, valamint ismertetni kórházunk ez irányú tapasztalatait. Bemutatjuk a lényeges európai és amerikai iránymutatásokat és az eddigi meghatározó tanulmányok főbb eredményeit. Közreadjuk a Zala Megyei Szent Rafael Kórházban 2014. 01. 01. és 2018. 12. 31. között operált 2735 beteg közül a műtét utáni egy hónapon belül végleges pacemaker-implantáción átesettek adatait, és összevetjük azokat a nemzetközi eredményekkel. A nemzetközi irodalom adatai alapján a korai posztoperatív időszakban a végleges pacemaker-beültetés aránya átlagosan 1,5–5% körül mozog a szívsebészetben, és ez az arány a későbbiekben tovább nő. Az ingerületvezetési zavarok kialakulásáról részletes információkkal rendelkezünk, számos prediktív tényező került azonosításra, az aktuális guideline-ok mégis csak hozzávetőleges iránymutatást kínálnak a kérdésben. A korai perioperatív időszak (1 hónap) során osztályunkon 15 esetben (0,55%) volt szükség végleges pacemaker implantációjára, és a késői utánkövetés során 6 beteg bírt továbbra is pacemakerdependens ritmuszavarral. A perioperatív ritmuszavarok gyakori és komoly következményekkel járó szövődmények a szívsebészetben, nehezítik a betegek gyors felépülését, terhet rónak a betegellátásra, és költségtöbbletet jelentenek. A végleges pacemaker-beültetés aránya a Zala Megyei Szent Rafael Kórházban alacsonynak mondható. A késői utánkövetés alapján a betegeknek így is csak töredéke pacemakerdependens. Az eddig rendelkezésre álló információk és egy hazai, nagy esetszámú, prospektív vizsgálat segítségével szükséges lenne standardizált protokoll kialakítása a témában, mely mérvadó lenne a szakma számára. Orv Hetil. 2020; 161(31): 1271–1280.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1

    Yater W, Cornell, V. Heart block due to calcareous lesions of the bundle of his: review and report of a case with detailed histopathologic study. Ann Intern Med. 1935; 8: 777–789.

  • 2

    Sellers R, Kanjuh V, Eliot RS, et al. Complete heart block following aortic and mitral valve replacement: anatomic basis, prevention and management. Circulation 1963; 28: 801.

  • 3

    Steyers CM 3rd, Khera R, Bhave P. Pacemaker dependency after cardiac surgery: a systematic review of current evidence. PLoS ONE 2015; 10: e0140340.

  • 4

    Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review. Part 1: general considerations in the management of epicardial pacing. Anaesthesia 2007; 62: 264–271. [Correction: Anaesthesia 2007; 62: 644.]

  • 5

    Emlein G, Huang SK, Pires LA, et al. Prolonged bradyarrhythmias after isolated coronary artery bypass graft surgery. Am Heart J. 1993; 126: 1084–1090.

  • 6

    Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review. Part 2: selection of epicardial pacing modes and troubleshooting. Anaesthesia 2007; 62: 364–373.

  • 7

    Jaeger FJ, Trohman RG, Brener S, et al. Permanent pacing following repeat cardiac valve surgery. Am J Cardiol. 1994; 74: 505–507.

  • 8

    Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. Circulation 2019; 140: e382–e482. [Correction: Circulation 2019; 140: e506–e508.]

  • 9

    Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013; 15: 1070–1118.

  • 10

    Baraki H, Al Ahmad A, Jeng-Singh S, et al. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg. 2013; 16: 476–481.

  • 11

    Robich MP, Schiltz NK, Johnston DR, et al. Risk factors and outcomes of patients requiring a permanent pacemaker after aortic valve replacement in the United States. J Card Surg. 2016; 31: 476–485.

  • 12

    Niclauss L, Delay D, Pfister R, et al. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. Asian Cardiovasc Thorac Ann. 2017; 25: 350–356.

  • 13

    Leyva F, Qiu T, McNulty D, et al. Long-term requirement for pacemaker implantation after cardiac valve replacement surgery. Heart Rhythm 2017; 14: 529–534.

  • 14

    Kumbhani DJ, Sharma GV, Khuri SF, et al. Fascicular conduction disturbances after coronary artery bypass surgery: a review with a meta-analysis of their long-term significance. J Card Surg. 2006; 21: 428–434.

  • 15

    Ferrari AD, Süssenbach CP, Guaragna JC, et al. Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution. Rev Bras Cir Cardiovasc. 2011; 26: 364–372.

  • 16

    Pires LA, Wagshal AB, Lancey R, et al. Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management, and prognosis. Am Heart J. 1995; 129: 799–808.

  • 17

    Gordon RS, Ivanov J, Cohen G, et al. Permanent cardiac pacing after a cardiac operation: predicting the use of permanent pacemakers. Ann Thorac Surg. 1998; 66: 1698–1704.

  • 18

    Piantá RM, Ferrari AD, Heck AA, et al. Atrioventricular block in coronary artery bypass surgery: perioperative predictors and impact on mortality. Rev Bras Cir Cardiovasc. 2015; 30: 164–172.

  • 19

    Caspi Y, Safadi T, Ammar R, et al. The significance of bundle branch block in the immediate postoperative electrocardiograms of patients undergoing coronary artery bypass. J Thorac Cardiovasc Surg. 1987; 93: 442–446.

  • 20

    Mosseri M, Meir G, Lotan C, et al. Coronary pathology predicts conduction disturbances after coronary artery bypass grafting. Ann Thorac Surg. 1991; 51: 248–252.

  • 21

    Hippeläinen M, Mustonen P, Manninen H, et al. Predictors of conduction disturbances after coronary bypass grafting. Ann Thorac Surg. 1994; 57: 1284–1288.

  • 22

    Kim MH, Deeb GM, Eagle KA, et al. Complete atrioventricular block after valvular heart surgery and the timing of pacemaker implantation. Am J Cardiol. 2001; 87: 649–651.

  • 23

    Goldman BS, Hill TJ, Weisel RD, et al. Permanent cardiac pacing after open-heart surgery: acquired heart disease. Pacing Clin Electrophysiol. 1984; 7: 367–371.

  • 24

    Koplan BA, Stevenson WG, Epstein LM, et al. Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery. J Am Coll Cardiol. 2003; 41: 795–801.

  • 25

    Onalan O, Crystal A, Lashevsky I, et al. Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up. Am J Cardiol. 2008; 101: 203–208.

  • 26

    Matthews IG, Fazal IA, Bates MG, et al. In patients undergoing aortic valve replacement, what factors predict the requirement for permanent pacemaker implantation? Interact Cardiovasc Thorac Surg. 2011; 12: 475–479.

  • 27

    Romano MA, Koeckert M, Mumtaz MA, et al. Permanent pacemaker implantation after rapid deployment aortic valve replacement. Ann Thorac Surg. 2018; 106: 685–690.

  • 28

    Steinberg BA, Harrison JK, Frazier-Mills C, et al. Cardiac conduction system disease after transcatheter aortic valve replacement. Am Heart J. 2012; 164: 664–671.

  • 29

    Ribeiro V, Mota Garcia R, Frutuoso C, et al. Permanent pacemaker implantation after aortic valve replacement: long-term dependency or rhythm recovery? Rev Port Cardiol. 2015; 34: 529–533.

  • 30

    Habicht JM, Scherr P, Zerkowski HR, et al. Late conduction defects following aortic valve replacement. J Heart Valve Dis. 2000; 9: 629–632.

  • 31

    Rene AG, Sastry A, Horowitz JM, et al. Recovery of atrioventricular conduction after pacemaker placement following cardiac valvular surgery. J Cardiovasc Electrophysiol. 2013; 24: 1383–1387.

  • 32

    Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med. 2000; 28: N136–N144.

  • 33

    Merin O, Ilan M, Oren A, et al. Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up. Pacing Clin Electrophysiol. 2009; 32: 7–12.

  • 34

    Ngaage DL, Schaff HV, Mullany CJ, et al. Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting? J Thorac Cardiovasc Surg. 2007; 133: 182–189.

  • 35

    Yesil M, Bayata S, Arikan E, et al. Should we revascularize before implanting a pacemaker? Clin Cardiol. 2008; 31: 498–501.

  • 36

    Dawkins S, Hobson AR, Kalra PR, et al. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors. Ann Thorac Surg. 2008; 85: 108–112.

  • 37

    Greason KL, Lahr BD, Stulak JM, et al. Long-term mortality effect of early pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg. 2017; 104: 1259–1264.

  • 38

    Schurr UP, Berli J, Berdajs D, et al. Incidence and risk factors for pacemaker implantation following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2010; 11: 556–560.

  • 39

    Berdajs D, Schurr UP, Wagner A, et al. Incidence and pathophysiology of atrioventricular block following mitral valve replacement and ring annuloplasty. Eur J Cardiothorac Surg. 2008; 34: 55–61.

  • 40

    Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med. 2016; 374: 344–353.

  • 41

    Chikwe J, Itagaki S, Anyanwu A, et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol. 2015; 65: 1931–1938.

  • 42

    Jokinen JJ, Turpeinen AK, Pitkänen O, et al. Pacemaker therapy after tricuspid valve operations: implications on mortality, morbidity, and quality of life. Ann Thorac Surg. 2009; 87: 1806–1814.

  • 43

    McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg. 2004; 127: 674–685.

  • 44

    Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14: e503–e551.

  • 45

    Patel AM, Verma D, Jiang SF, et al. Permanent pacemaker implantation early after cardiac surgery: a descriptive study of pacemaker utility after one year of follow-up. J Card Surg. 2016; 31: 132–138.

  • 46

    Glikson M, Dearani JA, Hyberger LK, et al. Indications, effectiveness, and long-term dependency in permanent pacing after cardiac surgery. Am J Cardiol. 1997; 80: 1309–1313.

  • 47

    Wiggins NB, Chong DT, Houghtaling PL, et al. Incidence, indications, risk factors, and survival of patients undergoing cardiac implantable electronic device implantation after open heart surgery. Europace 2017; 19: 1335–1342.

  • 48

    Raza SS, Li JM, John R, et al. Long-term mortality and pacing outcomes of patients with permanent pacemaker implantation after cardiac surgery. Pacing Clin Electrophysiol. 2011; 34: 331–338.

 

The author instructions are available in PDF.
Instructions for Authors in Hungarian HERE.

 

Mendeley citation style is available HERE.
  • Impact Factor (2019): 0.497
  • Scimago Journal Rank (2018): 0.176
  • SJR Hirsch-Index (2018): 20
  • SJR Quartile Score (2018): Q3 Medicine (miscellaneous)
  • Impact Factor (2018): 0.564
  • Scimago Journal Rank (2018): 0.193
  • SJR Hirsch-Index (2018): 18
  • SJR Quartile Score (2018): Q3 Medicine (miscellaneous)

Language: Hungarian

Founded in 1857
Publication: Weekly, one volume of 52 issues annually

Senior editors

Editor(s)-in-Chief: Papp Zoltán

Read the professional career of Papp Zoltán HERE.

 

Editorial Board

Click for the Editorial Board

Akadémiai Kiadó
Address: Prielle Kornélia u. 21-35. H-1117 Budapest, Hungary
Phone: (+36 1) 464 8235 ---- Fax: (+36 1) 464 8221
Email: orvosihetilap@akkrt.hu