초록접수 현황
| 14F-279 | 구연 발표 |
Lack of Atrial Contraction as a Predictor for Permanent Pacemaker Implantation after the Cryo-maze Procedure Combined with Valve Surgery
박상준, 정동섭, 조양현, 성기익, 김욱성, 이영탁, 박표원
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
Background : The lack of atrial contraction (AC) after the Maze procedure is reported to cause subsequent annulus dilatation and an increase in embolic stroke. We hypothesized that the lack of AC could increase the risk of permanent pacemaker (PPM) implantation in patients undergoing the Maze and valve surgery.
Methods : In 376 consecutive patients who had undergone the cryo-Maze and combined valve operation, recovery of AC was assessed using Doppler echocardiographic measurement of the transmitral A-wave velocity at baseline, immediate (≤2weeks), early (≤1yr; 4.6±3.8months), and late (>1yr; 3.5±1.1years) postoperative stages.
Results : During the median 53 month follow-up, 10 patients (8 female, 61±13years) underwent PPM implantation; 7 for sinus node dysfunction (pauses, 9.6±2.4sec), 1 for marked sinus bradycardia, and 2 for advanced/complete atrioventricular block. Median (interquartile range) time to the PPM implantation was 13.8 (0.5−68.2) months. Patients with PPM implantation showed a more frequent lack of AC versus those without PPM implantation in the early stage (P=0.005). Multivariate analysis revealed that the lack of AC in the early stage was identified as an independent predictor for PPM implantation (odds ratio 5.62, 95% confidence interval 1.06 to 30.0, P=0.039).
Conclusion : The lack of AC was independently associated with subsequent risk of PPM implantation. Therefore, close follow-up might be needed when the atrial contraction is not recovered during follow-up.
Methods : In 376 consecutive patients who had undergone the cryo-Maze and combined valve operation, recovery of AC was assessed using Doppler echocardiographic measurement of the transmitral A-wave velocity at baseline, immediate (≤2weeks), early (≤1yr; 4.6±3.8months), and late (>1yr; 3.5±1.1years) postoperative stages.
Results : During the median 53 month follow-up, 10 patients (8 female, 61±13years) underwent PPM implantation; 7 for sinus node dysfunction (pauses, 9.6±2.4sec), 1 for marked sinus bradycardia, and 2 for advanced/complete atrioventricular block. Median (interquartile range) time to the PPM implantation was 13.8 (0.5−68.2) months. Patients with PPM implantation showed a more frequent lack of AC versus those without PPM implantation in the early stage (P=0.005). Multivariate analysis revealed that the lack of AC in the early stage was identified as an independent predictor for PPM implantation (odds ratio 5.62, 95% confidence interval 1.06 to 30.0, P=0.039).
Conclusion : The lack of AC was independently associated with subsequent risk of PPM implantation. Therefore, close follow-up might be needed when the atrial contraction is not recovered during follow-up.
책임저자: 박표원
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
연락처 : 박상준, Tel: 02-3410-3488 , E-mail : sangjun123.park@samsung.com
