On average, implanted valves were 21.7 ± 2.1 mm in diameter. Overall, 43% of patients had bicuspid aortic valves and 46.8% of patients had implanted mechanical aortic valves. The prevalence of medical conditions, including hypertension, diabetes, cerebrovascular disease, chronic lung disease, coronary artery disease, chronic kidney disease, and arrhythmias diagnosed before AVR, was comparable between patients with PPM and patients without PPM. There were no significant differences in baseline and operative variables between patients with PPM and patients without PPM ( Table 1). During this time, 10 patients (1.5%) received an implantable PPM for post-AVR conduction disorders ( Figure 1), with 39 patients (5.9%) lost to follow-up. The mean follow-up duration was 1288 ± 1122 days. The mean age of the study population was 67.1 ± 8.1 years, and 362 patients were male (54.6%). Statistical AnalysisĪ total of 663 patients with pathologically proven degenerative AS who underwent isolated AVR and had ECG data were included. Our study protocol was approved by the Institutional Review Board of Asan Medical Center (Seoul, South Korea Institutional Review Board No. Pacemaker dependency was defined as the presence of an intrinsic escape rhythm of less than 40 beats/min and a percentage of pacing more than 80%. In patients with implantable devices, device-related data such as the device type and mode, and pacemaker dependency were obtained. We reviewed all ECG data (including Holter data) from the preoperative period to the most recent follow-up date. Prespecified conduction disorders included (1) intraventricular conduction disorders including bundle branch block and nonspecific intraventricular conduction delay (IVCD) and (2) atrioventricular conduction disorders such as first-degree atrioventricular block (AVB), second-degree AVB (Mobitz type 1), and symptomatic second- or third-degree AVB. At each time point, we reviewed ECGs with respect to (1) rhythm (sinus rhythm, atrial fibrillation, atrial flutter, and junctional or pacemaker rhythm) (2) presence and type of conduction disturbances and (3) measurable intervals (PR, QRS, and corrected QT intervals). ConclusionsĮlectrocardiogram (ECG) data were reviewed and analyzed at baseline (preoperative), within 30 days after surgery, and more than 30 days after surgery. Beyond 30 days after aortic valve replacement, 1 patient underwent permanent pacemaker implantation for de novo conduction disturbance 44 months postoperatively. Of the 10 patients requiring permanent pacemakers, 4 remained depend on the permanent pacemaker during follow-up. During the mean follow-up period of 1288 ± 1122 days, 64 patients (9.7%) developed irreversible conduction disorders (bundle branch block n = 24 and first-degree atrioventricular block n = 42). Ten patients with symptomatic second-degree or third-degree atrioventricular block underwent permanent pacemaker implantation within 30 days of aortic valve replacement. Immediate postoperative intraventricular conduction disorders occurred in 56 patients (8.4%), and atrioventricular block occurred in 68 patients (10.3%). We reviewed results of 663 patients with pathologically proven degenerative aortic stenosis (bicuspid aortic valve, n = 285 ) who underwent isolated aortic valve replacement (mechanical valve, n = 310 ).
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