Abstract

Aim: Our aim was to identify predictors for Permanent Pacemaker (PPM) implantation.

Methods: We performed a retrospective analysis of patients under 18 years of age who received postoperative pacing through a temporary external pacemaker, between 2002 and 2020. Patients were divided in two groups: 1) permanent, when a PPM was implanted before discharge or 2) temporary if PPM was not implanted. Demographic characteristics, anatomic diagnosis and perioperative variables of the two groups were compared.

Results: Overall, 2.985 patients were operated and 286 (9.6%) received postoperative pacing. Temporary pacing was performed in 245 (8.2%) patients and 41 (1.4%) patients received a PPM. Independence from the temporary external pacemaker was achieved in 91% of patients of the temporary group on day 10. Patients in the permanent group needed pacing from the first hour of admission to PICU much more often than patients in the temporary group (92.7% vs 60.4%, p < 0.001). On univariable analysis, increased age (p = 0.02) and number of previous surgeries (p = 0.02) and segmental anatomy {S,L,L} (p = 0.04) were significantly higher in the permanent group. Multivariable logistic regression analysis identified that increased number of previous cardiac surgeries (OR = 1.99, 95% CI = 1. 1.21 - 3.29, p = 0.007) was an independent risk factor for PPM implantation.

Conclusion: Patients with need for pacing from the first hour of admission to PICU, persistent need beyond the 10^th postoperative day, atrioventricular discordance and especially those who had multiple previous surgeries are more likely to require permanent pacing.

Keywords: Postoperative Pacing; Permanent Pacemaker Implantation; Children; Heart Surgery; Congenital Heart Disease

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