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High incidence of permanent pacemaker after Cox-maze IV and mitral valve surgery : a nationwide registry-based study

Ivert, Torbjörn ; Boano, Gabriella ; Vanky, Farkas ; Gadler, Fredrik ; Holmgren, Anders ; Jidéus, Lena ; Johansson, Birgitta ; Kennebäck, Göran ; Nozohoor, Shahab LU orcid and Scherstén, Henrik , et al. (2025) In Interdisciplinary Cardiovascular and Thoracic Surgery 40(4).
Abstract

OBJECTIVES: This study evaluated the long-term risk of permanent pacemaker implantation following Cox-maze IV (CMIV) and concurrent mitral valve surgery. METHODS: A retrospective, nationwide, registry-based analysis was conducted on postoperative permanent pacemaker implantation in 397 patients with symptomatic mitral valve insufficiency and atrial fibrillation who underwent CMIV and mitral valve surgery in Sweden between 2009 and 2017. They were compared to a registry group of 346 patients with atrial fibrillation who underwent mitral valve surgery without surgical ablation during 2014–2017. The follow-up ended on 30 September 2022. RESULTS: CMIV patients were on average 4 years younger and had lower surgical risk than registry... (More)

OBJECTIVES: This study evaluated the long-term risk of permanent pacemaker implantation following Cox-maze IV (CMIV) and concurrent mitral valve surgery. METHODS: A retrospective, nationwide, registry-based analysis was conducted on postoperative permanent pacemaker implantation in 397 patients with symptomatic mitral valve insufficiency and atrial fibrillation who underwent CMIV and mitral valve surgery in Sweden between 2009 and 2017. They were compared to a registry group of 346 patients with atrial fibrillation who underwent mitral valve surgery without surgical ablation during 2014–2017. The follow-up ended on 30 September 2022. RESULTS: CMIV patients were on average 4 years younger and had lower surgical risk than registry patients. More CMIV patients underwent early (<30 days) pacemaker implantation (13.3% vs. 5.5%, P = 0.002). CMIV patients had a doubled adjusted risk of requiring a pacemaker compared to registry patients after 8 years [HR 1.96, 95% CI 1.27–3.04]. In the CMIV group, 22% (95% CI 18–26%) had a pacemaker by 5 years, increasing to 27% (95% CI 22–31%) by 8 years, compared to 13% (95% CI 10–17%) at both time intervals in the registry group. Atrioventricular block II/III accounted for >60% of early pacemaker indications in both groups, and sinus node dysfunction was the indication for late pacemaker implantation in 48% in the CMIV group. CONCLUSIONS: Patients undergoing CMIV concomitant with mitral valve surgery have a higher rate of postoperative pacemaker implantation compared to patients with atrial fibrillation undergoing mitral valve surgery alone. Sinus node dysfunction was the main indication for late pacemaker among CMIV patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cox-maze, mitral valve surgery, pacemaker
in
Interdisciplinary Cardiovascular and Thoracic Surgery
volume
40
issue
4
article number
ivaf085
publisher
Oxford University Press
external identifiers
  • pmid:40184218
  • scopus:105003499296
DOI
10.1093/icvts/ivaf085
language
English
LU publication?
yes
id
bad99e8f-05b1-4cb4-be6d-4aa0c800c625
date added to LUP
2025-08-12 15:28:12
date last changed
2025-08-13 10:27:21
@article{bad99e8f-05b1-4cb4-be6d-4aa0c800c625,
  abstract     = {{<p>OBJECTIVES: This study evaluated the long-term risk of permanent pacemaker implantation following Cox-maze IV (CMIV) and concurrent mitral valve surgery. METHODS: A retrospective, nationwide, registry-based analysis was conducted on postoperative permanent pacemaker implantation in 397 patients with symptomatic mitral valve insufficiency and atrial fibrillation who underwent CMIV and mitral valve surgery in Sweden between 2009 and 2017. They were compared to a registry group of 346 patients with atrial fibrillation who underwent mitral valve surgery without surgical ablation during 2014–2017. The follow-up ended on 30 September 2022. RESULTS: CMIV patients were on average 4 years younger and had lower surgical risk than registry patients. More CMIV patients underwent early (&lt;30 days) pacemaker implantation (13.3% vs. 5.5%, P = 0.002). CMIV patients had a doubled adjusted risk of requiring a pacemaker compared to registry patients after 8 years [HR 1.96, 95% CI 1.27–3.04]. In the CMIV group, 22% (95% CI 18–26%) had a pacemaker by 5 years, increasing to 27% (95% CI 22–31%) by 8 years, compared to 13% (95% CI 10–17%) at both time intervals in the registry group. Atrioventricular block II/III accounted for &gt;60% of early pacemaker indications in both groups, and sinus node dysfunction was the indication for late pacemaker implantation in 48% in the CMIV group. CONCLUSIONS: Patients undergoing CMIV concomitant with mitral valve surgery have a higher rate of postoperative pacemaker implantation compared to patients with atrial fibrillation undergoing mitral valve surgery alone. Sinus node dysfunction was the main indication for late pacemaker among CMIV patients.</p>}},
  author       = {{Ivert, Torbjörn and Boano, Gabriella and Vanky, Farkas and Gadler, Fredrik and Holmgren, Anders and Jidéus, Lena and Johansson, Birgitta and Kennebäck, Göran and Nozohoor, Shahab and Scherstén, Henrik and Sjögren, Johan and Wickbom, Anders and Friberg, Örjan and Albåge, Anders}},
  keywords     = {{Cox-maze; mitral valve surgery; pacemaker}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  publisher    = {{Oxford University Press}},
  series       = {{Interdisciplinary Cardiovascular and Thoracic Surgery}},
  title        = {{High incidence of permanent pacemaker after Cox-maze IV and mitral valve surgery : a nationwide registry-based study}},
  url          = {{http://dx.doi.org/10.1093/icvts/ivaf085}},
  doi          = {{10.1093/icvts/ivaf085}},
  volume       = {{40}},
  year         = {{2025}},
}