Abstract 16396: Characteristics, Indications and Outcomes of Pacemaker Use for Treatment of Conduction Abnormalities in Patients With Infective Endocarditis Requiring Valve Replacement
Introduction: Conduction abnormalities secondary to Infective Endocarditis are associated with increased morbidity and mortality. Our study describes the frequency, indications and outcomes of pacemaker use in patients with Infective Endocarditis needing valve replacement.
Methods: We queried the Nationwide Inpatient Survey Database from 1998 to 2013. Our study population was patients with a primary diagnosis of Infective Endocarditis undergoing valve replacement. In this cohort,we describe baseline characteristics and predictors of mortality in patients that underwent pacemaker insertion. We performed logistic regression analysis with mortality as the primary outcome. Our conduction disorders of interest were Right Bundle Brach Block, Left Bundle Branch Block, First Degree AV Block, Second Degree AV Block (Mobitz type II), Complete Heart Block and Sinus Node Dysfunction.
Results: A total of 19% (n=6,261) of patients with a primary diagnosis of Infective endocarditis (n=52,998) required valve surgery. 776 (12.4%) patients undergoing surgery had conduction abnormalities. Of these, 560 (72.2%) were male. There was a statistically significant difference in pacemaker use in favor of all the conduction abnormalities studied except in trifascicular block (n=3). Pacemakers were implanted in 489(7.8%) of patients undergoing valve replacement. Among patients who had any of the conduction abnormalities studied, patients that received a pacemaker were also more likely to have a longer length of hospital stay (p=.001) and be discharged to a skilled nursing facility. Mortality was however lower in patients that received a pacemaker (4% vs 8% p=.035). When adjusted for type of valve replaced and adverse post-procedural events (TIA/Stroke, Respiratory failure, acute renal failure, cardiogenic shock, cardiac arrest/ventricular fibrillation), pacemaker placement was associated with lower mortality [OR= .457 95% CI= .236-.883; p value= .02]. This was mainly driven by pacemaker insertion for complete heart block [OR .310 95% CI .145-.666; p value 0.003].
Conclusions: In patients undergoing valve replacement for Infective endocarditis, pacemaker placement in patients with complete heart block was associated with odds for lower mortality.
Author Disclosures: G.O. Ogunbayo: None. O. Olorunfemi: None. A. Elbadawi: None. D. Saheed: None.
- © 2016 by American Heart Association, Inc.