Analysis of the causes and frequency of permanent pacemaker implantation after different variants of surgical treatment of atrial fibrillation with combined cardiac surgery

• Georgy N. Antipov
• Postol A.S.
• Kotov S.N.
• Makarova M.O.
• Schneider Yu.A.

Abstract

The aim of the study was to conduct a retrospective analysis of the causes and frequency of permanent pacemaker implantation (PPM) after different variants of surgical treatment of atrial fibrillation (AF) in cases of concomitant cardiac surgeries.

Material and methods. From January 2013 to February 2021, 558 patients were operated on with 4 variants of surgical treatment of AF combined with other interventions on the heart: 1 - the classic version of the maze III procedure (cut-and-sew BA maze), 2 - left atrial part of the maze III procedure (LA maze), 3 - maze IV (radio frequency ablation - RFA), 4 - cryomaze McCarthy's modification (the group was initially excluded from the analysis, due to the lack of long-term results, since it has been performed since 2020). Coronary artery bypass grafting and/or valve correction were performed as combined procedures. The mean duration of long-term follow-up was 33.7±24.9 months [32 (1-97) months]. The rhythm was assessed based on the results of 24-hour Holter monitoring. Indications for pacemaker implantation were sick sinus syndrome (heart rate less than 60 beats per min without adequate adaptation to physical activity) and some disorders of atrioventricular conduction.

Results. After analyzing the three groups, the RFA group was excluded due to significant differences from the first two groups. Further, propensity score matching (PSM) analysis of the BA and LP groups of the maze was performed. As a result of the analysis performed using the logistic regression method, 2 factors influencing the frequency of pacemaker implantation were determined: age (OR=1.050; 95% CI 1.014-1.088; p=0.007) and duration of AF (OR=1.007; 95% CI 1.002-1.012; p=0.004). The frequency of pacemaker implantation in the long-term follow-up did not significantly differ between the groups (28.3 versus 20.6%; p=0.059), however, the mean time of pacemaker implantation differed (25.5 versus 7.1 months; p<0.001).

Conclusion. A total of 110 pacemakers were implanted in the comparison groups. 82.7% of patients have effective atrial pacing (AAIR and DDDR modes). In 6 (5.4%) cases, an upgrade was performed (the VVI device was implanted earlier, maintaining the sinoatrial rhythm after the maze procedure, replacing the device with DDDR). The presence of a pacemaker is not associated with an increase in the incidence of early and late complications or with a return of atrial arrhythmias.

Keywords:atrial fibrillation, maze procedure, permanent pacemaker implantation

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