Aimée M. Mercado-Domínguez, Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Rodrigo Gopar-Nieto, Unidad de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Gustavo Rojas-Velasco, Unidad de Cuidados Intensivos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Manzur-Sandoval, Unidad de Cuidados Intensivos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Introduction: Cardiac rhythm disturbances, such as atrioventricular block (AVB) and sinus node dysfunction, are common complications after cardiac surgery and may require temporary or permanent pacing. Although various predisposing factors have been proposed, uncertainty remains regarding which patients ultimately require permanent pacemaker (PM) implantation. Method: This was a retrospective, observational, cross-sectional study conducted at the Instituto Nacional de Cardiología Ignacio Chávez between June 2022 and December 2023. A total of 486 adult patients undergoing cardiac surgery with cardiopulmonary bypass were included. Patients were categorized into three groups according to pacing requirements: no PM, temporary PM only, and temporary PM followed by permanent PM. Clinical, surgical, and postoperative variables were analyzed using appropriate statistical tests (χ2, Mann-Whitney U). Results: Of the patients, 51.2% required no PM, 42.4% required temporary PM only, and 6.2% received a permanent PM. Atrial fibrillation at baseline was significantly more prevalent in the permanent PM group (p = 0.02), as was perioperative AVB (84.8%). This group also showed longer aortic cross-clamp times (p = 0.01), higher incidence of hospital-acquired pneumonia (p = 0.04), acute kidney injury (p = 0.03), and longer hospital stay (p = 0.0004). No significant differences were found in age, sex, or traditional comorbidity. Conclusions: Baseline atrial fibrillation, perioperative AVB, and prolonged surgical times were significantly associated with permanent PM implantation. Early identification of these risk factors may aid in optimizing perioperative management and postoperative follow-up in cardiac surgery patients.
Keywords: Cardiac surgical procedures. Heart conduction system. Artificial pacemaker. Postoperative complications. Atrioventricular block.