Pacemaker Implantation for Atrial Fibrillation with Bradycardia in Patients with Mitral Valve Disease

(Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan and Department of Cardiovascular Surgery, Kashiwa Hospital, Tokyo Jikei University School of Medicine*, Kashiwa, Japan)

Yoshihiro Ko Shigeki Horikoshi* Asatoshi Mizuno*
Isao Aoki* Shingo Taguchi*
Some cases of atrial fibrillation and bradycardia show improvement in slow ventricular response after valvular surgery. However, there is still no established view regarding the indications of pacemaker implantation for the bradyarrhythmia with valvular disease. In 24 cases (permanent pacing group: 15, non-pacing group: 9) of those with bradyarrhythmia who were fitted with a myocardial pacing lead at the time of valvular surgery, we examined predictions of pacemaker implantation and the role of valvular surgery for the bradyarrhythmia. The permanent pacing group showed much larger values than the non-pacing group in regard to preoperative NYHA, right and left atrial pressure, and duration of atrial fibrillation. After valvular surgery, many cases that had significantly decreased left atrial pressure after operation improved with regard to bradycardia. We should judge the indication of pacemaker implantation after valvular surgery from the evaluation of preoperative hemodynamics and early postoperative cardiac function. Because atrial fibrillation tends to accompany bradycardia due to chronic atrial load, we must make an effort to promote the rapid recovery of cardiac function by doing valvular surgery as early as possible.
@Jpn. J. Cardiovasc. Surg. 31F382-384 (2002)