Criteria for Early Pacemaker Implantation in Patients With Postoperative Heart Block After Congenital Heart Surgery.

Link: https://doi.org/10.1161/CIRCEP.122.011145
Authors: Duong, Son Q; Shi, Yuan; Giacone, Heather; Navarre, Brittany M; Gal, Dana B; Han, Brian; Sganga, Danielle; Ma, Michael; Reddy, Charitha D; Shin, Andrew Y; Kwiatkowski, David M; Dubin, Anne M; Scheinker, David; Algaze, Claudia A

Abstract: Guidelines recommend observation for atrioventricular node recovery until postoperative days (POD) 7 to 10 before permanent pacemaker placement (PPM) in patients with heart block after congenital cardiac surgery. To aid in surgical decision-making for early PPM, we established criteria to identify patients at high risk of requiring PPM. We reviewed all cases of second degree and complete heart block (CHB) on POD 0 from August 2009 through December 2018. A decision tree model was trained to predict the need for PPM amongst patients with persistent CHB and prospectively validated from January 2019 through March 2021. Separate models were developed for all patients on POD 0 and those without recovery by POD 4. A data-driven analysis led to actionable criteria to identify patients requiring PPM. Patients with left ventricular outflow tract surgery, atrioventricular valve replacement, or ventricular L-Looping could be considered for PPM on POD 4 to reduce risks of temporary pacing and improve care efficiency.