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J Thorac Cardiovasc Surg. 2019 Mar;157(3):1168-1177.e2. doi: 10.1016/j.jtcvs.2018.09.142. Epub 2018 Nov 24.

Atrioventricular block after congenital heart surgery: Analysis from the Pediatric Cardiac Critical Care Consortium.

Author information

1
Department of Pediatrics, Division of Cardiology, Stanford University, Palo Alto, Calif. Electronic address: aromer@stanford.edu.
2
Department of Pediatrics, Division of Critical Care, University of California, San Francisco, San Francisco, Calif.
3
Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah.
4
Department of Pediatrics, Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Ga.
5
Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex.
6
Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of California, San Francisco, San Francisco, Calif.
7
Department of Pediatrics, Division of Cardiology, New York University School of Medicine, New York, NY.
8
Department of Pediatrics, Division of Cardiology, University of California, San Francisco, San Francisco, Calif.
9
Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
10
Department of Pediatrics and Communicable Disease, Division of Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, Mich.
11
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich.
12
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Mich.

Abstract

OBJECTIVES:

Our primary aims were to describe the contemporary epidemiology of postoperative high-grade atrioventricular block (AVB), the timing of recovery and permanent pacemaker (PPM) placement, and to determine predictors for development of and recovery from AVB.

METHODS:

Patients who underwent congenital heart surgery from August 2014 to June 2017 were analyzed for AVB using the Pediatric Cardiac Critical Care Consortium registry. Predictors of AVB with or without PPM were identified using multinomial logistic regression. We used these predictors to model the probability of PPM for the subgroup of patients with intraoperative complete AVB.

RESULTS:

We analyzed 15,901 surgical hospitalizations; 422 (2.7%) were complicated by AVB and 162 (1.0%) patients underwent PPM placement. In patients with transient AVB, 50% resolved by 2 days, and 94% resolved by 10 days. In patients who received a PPM, 50% were placed by 8 days and 62% were placed by 10 days. Independent risk factors associated with PPM compared with resolution of AVB were longer duration of cardiopulmonary bypass (relative risk ratio, 1.04; P = .023) and a high-risk operation (relative risk ratio, 2.59; P < .001). Among patients with complete AVB originating in the operating room, those with the highest predicted probability of PPM had a PPM placed only 77% of the time.

CONCLUSIONS:

In this cohort, postoperative AVB complicated almost 3% of congenital heart surgery cases and 1% of patients underwent PPM placement. Because almost all patients (94%) with transient AVB had resolution by 10 days, our results suggest there is limited benefit to delaying PPM placement beyond that time frame.

KEYWORDS:

congenital heart disease; database; pacemaker; pediatric

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