Introduction: The incidence of infective endocarditis (IE) in the United States has been increasing over the last decade and many patients require surgical intervention. Cardiac conduction disease frequently complicates endocarditis. We sought to evaluate pre-operative risk factors for needing a permanent pacemaker (PPM) after surgery for infective endocarditis.
Methods: Patients admitted to Cleveland Clinic for endocarditis from 1/1/2007 through 2/3/2013 who underwent cardiac surgery for endocarditis and did not have a pre-existing cardiac implantable electronic device were included. Cases of IE were ascertained through an IRB approved IE registry. Data were analyzed using multi-variable logistic regression to create a model for PPM requirement for atrioventricular block (AV) block after surgery. Patients who died post-operatively were excluded from the analysis.
Results: Among 468 operated patients who met inclusion criteria, 24 patients who died during the index admission were excluded. The aortic valve was most commonly involved (66%). Overall, 43% had prosthetic valve disease, 21% had multiple valves involved, and 39% had a valvular abscess. Pre-operative conduction disease was common (20% had a new first degree AV block, but only 3% had pre-operative complete heart block). The overall rate of post-operative PPM for an indication of high-degree AVB was 12.8%. Results from the multi-variable regression analysis are shown in Figure 1, generating a c-statistic of 0.88 with good model calibration.
Conclusions: Conduction disease requiring post-operative PPM is common in patients undergoing surgery for IE. Risk factors for PPM requirement after surgery include abnormal pre-operative conduction on ECG, staphylococcus aureus infections, a history of prior valve surgery, tricuspid valve endocarditis, and presence of an abscess.