# Pacemakerimplantatie na mitralisklepchirurgie met AF-ablatie

*geplaatst 2019-05-21 · Atriumfibrilleren · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.02.062 · https://hartvaat.nl/2019/05/21/pacemakerimplantatie-na-mitralisklepchirurgie-met-af-ablatie/*

Studie naar de incidentie van pacemakerimplantatie na mitralisklepchirurgie gecombineerd met AF-ablatie.

## English: Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.

This study documented the incidence of permanent pacemaker implantation after mitral valve surgery combined with AF ablation, showing that concomitant rhythm surgery increases the need for permanent pacing.

## Abstract (original, from the publication)

BACKGROUND: The incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone. OBJECTIVES: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS. METHODS: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality. RESULTS: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class. CONCLUSIONS: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370).

Auteurs: Joseph J DeRose, Donna M Mancini, Helena L Chang, Michael Argenziano, François Dagenais, Gorav Ailawadi, Louis P Perrault, Michael K Parides, Wendy C Taddei-Peters, Michael J Mack, Donald D Glower, Babatunde A Yerokun, Pavan Atluri, John C Mullen, John D Puskas, Karen O'Sullivan, Nancy M Sledz, Hugo Tremblay, Ellen Moquete, Bart S Ferket, Alan J Moskowitz, Alexander Iribarne, Annetine C Gelijns, Patrick T O'Gara, Eugene H Blackstone, A Marc Gillinov

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.02.062. Bijgewerkt 2026-07-03T13:27:08Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.