Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Short Communication

Volume 11, Number 1, February 2020, pages 56-60

Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease

**Table 1.** Characteristic of Patients With Carcinoid Heart Disease Who Underwent a Valve Replacement Surgery According to Post-Surgical Permanent Pacemaker Placement
	Overall (n = 19)	Post-surgical PPM placement
Values are number (%) or mean ± standard deviation. ^aFisher’s exact test or t-test. ^bAverage age in years at time of surgery or during last visit. ^cDiagnosed via left heart catheterization. ^dBody mass index ≥ 30 kg/m². AVB: atrioventricular block; AVR: aortic valve replacement; EKG: electrocardiogram; LVEF: left ventricular ejection fraction; ms: millisecond; NYHA: New York Heart Association; PPM: permanent pacemaker; PVR: pulmonary valve replacement; RBBB: right bundle branch block; RV: right ventricle; RVSP: right ventricular systolic pressure; TTE: transthoracic echocardiogram; TVR: tricuspid valve replacement.
Demographic and comorbidity profile
Age^b, years	60.4 ± 1.9	63.2 ± 1.9	59.2 ± 2.6	0.331
Male	11 (57.9)	1 (16.7)	10 (76.9)	0.041
Hypertension	12 (63.2)	1 (16.7)	11 (84.6)	0.010
Diabetes mellitus	3 (15.8)	1 (16.7)	2 (15.4)	1.000
Hyperlipidemia	4 (21.1)	1 (16.7)	3 (23.1)	1.000
Coronary artery disease^c	2 (10.5)	1 (16.7)	1 (7.7)	1.000
Atrial fibrillation	7 (36.9)	4 (66.7)	3 (23.1)	0.129
Obesity^d	4 (21.1)	0 (0.0)	4 (33.8)	0.255
NYHA class III/IV	19 (100)	6 (100)	13 (100)	-
Prior treatment
Prior valve surgery	2 (10.5)	1 (16.7)	1 (7.7)	1.000
Prior octreotide treatment	19 (100)	6 (100)	13 (100)	-
Pre-surgical EKG parameters
First degree AVB	3 (15.8)	0 (0.0)	3 (23.1)	0.522
≥ Second degree AVB	0 (0)	0 (0)	0 (0)	-
RBBB	3 (15.8)	0 (0.0)	3 (23.1)	0.517
Left fascicular block	2 (10.5)	1 (16.7)	1 (7.7)	1.000
PR interval (ms)	167.6 ± 13.0	158.8 ± 9.8	171.6 ± 18.6	0.660
QRS interval (ms)	102.3 ± 4.0	104.2 ± 10.7	101.5 ± 3.7	0.765
Pre-surgical TTE parameters
LVEF (%)	54.6 ± 1.2	56.8 ± 1.9	53.5 ± 1.5	0.236
Reduced RV function	15 (79.0)	4 (66.7)	11 (84.6)	0.557
RVSP (mm Hg)	32.0 ± 3.0	35.0 ± 9.1	30.9 ± 2.8	0.566
Pulmonary insufficiency, moderate to severe	12 (63.2)	2 (33.3)	10 (76.9)	0.129
Pulmonary stenosis	11 (58.9)	3 (50.0)	8 (61.5)	1.000
Tricuspid regurgitation, moderate to severe	18 (94.7)	6 (100.0)	12 (92.3)	1.000
Tricuspid stenosis	6 (31.6)	1 (16.7)	5 (38.5)	0.605
Post-surgical TTE parameters^a
LVEF (%)	55.6 ± 2.2	55.8 ± 4.0	55.5 ± 2.8	0.945
Reduced RV function	7 (43.8)	3 (50.0)	4 (40.0)	1.000
RVSP (mm Hg)	30.3 ± 2.5	36.0 ± 5.1	28.0 ± 2.7	0.161
Type of surgery				0.088
PVR	1 (6.3)	0 (0.0)	1 (7.7)
PVR + TVR	16 (84.2)	4 (66.7)	12 (92.3)
PVR + TVR + AVR	2 (10.5)	2 (33.3)	0 (0.0)
Post-surgical mortality	2 (10.5)	1 (16.7)	1 (7.7)	1.000
Operative (30 days)	0 (0.0)	0 (0.0)	0 (0.0)	-
During 6-months follow up	2 (10.5)	1 (16.7)	1 (7.7)	1.000

Table 1. Characteristic of Patients With Carcinoid Heart Disease Who Underwent a Valve Replacement Surgery According to Post-Surgical Permanent Pacemaker Placement

Overall (n = 19)

Post-surgical PPM placement

PPM (n = 6)

No PPM (n = 13)

P value^a

Values are number (%) or mean ± standard deviation. ^aFisher’s exact test or t-test. ^bAverage age in years at time of surgery or during last visit. ^cDiagnosed via left heart catheterization. ^dBody mass index ≥ 30 kg/m². AVB: atrioventricular block; AVR: aortic valve replacement; EKG: electrocardiogram; LVEF: left ventricular ejection fraction; ms: millisecond; NYHA: New York Heart Association; PPM: permanent pacemaker; PVR: pulmonary valve replacement; RBBB: right bundle branch block; RV: right ventricle; RVSP: right ventricular systolic pressure; TTE: transthoracic echocardiogram; TVR: tricuspid valve replacement.

Demographic and comorbidity profile

Age^b, years

60.4 ± 1.9

63.2 ± 1.9

59.2 ± 2.6

0.331

Male

11 (57.9)

1 (16.7)

10 (76.9)

0.041

Hypertension

12 (63.2)

1 (16.7)

11 (84.6)

0.010

Diabetes mellitus

3 (15.8)

1 (16.7)

2 (15.4)

1.000

Hyperlipidemia

4 (21.1)

1 (16.7)

3 (23.1)

1.000

Coronary artery disease^c

2 (10.5)

1 (16.7)

1 (7.7)

1.000

Atrial fibrillation

7 (36.9)

4 (66.7)

3 (23.1)

0.129

Obesity^d

4 (21.1)

0 (0.0)

4 (33.8)

0.255

NYHA class III/IV

19 (100)

6 (100)

13 (100)

Prior treatment

Prior valve surgery

2 (10.5)

1 (16.7)

1 (7.7)

1.000

Prior octreotide treatment

19 (100)

6 (100)

13 (100)

Pre-surgical EKG parameters

First degree AVB

3 (15.8)

0 (0.0)

3 (23.1)

0.522

≥ Second degree AVB

0 (0)

RBBB

3 (15.8)

0 (0.0)

3 (23.1)

0.517

Left fascicular block

2 (10.5)

1 (16.7)

1 (7.7)

1.000

PR interval (ms)

167.6 ± 13.0

158.8 ± 9.8

171.6 ± 18.6

0.660

QRS interval (ms)

102.3 ± 4.0

104.2 ± 10.7

101.5 ± 3.7

0.765

Pre-surgical TTE parameters

LVEF (%)

54.6 ± 1.2

56.8 ± 1.9

53.5 ± 1.5

0.236

Reduced RV function

15 (79.0)

4 (66.7)

11 (84.6)

0.557

RVSP (mm Hg)

32.0 ± 3.0

35.0 ± 9.1

30.9 ± 2.8

0.566

Pulmonary insufficiency, moderate to severe

12 (63.2)

2 (33.3)

10 (76.9)

0.129

Pulmonary stenosis

11 (58.9)

3 (50.0)

8 (61.5)

1.000

Tricuspid regurgitation, moderate to severe

18 (94.7)

6 (100.0)

12 (92.3)

1.000

Tricuspid stenosis

6 (31.6)

1 (16.7)

5 (38.5)

0.605

Post-surgical TTE parameters^a

LVEF (%)

55.6 ± 2.2

55.8 ± 4.0

55.5 ± 2.8

0.945

Reduced RV function

7 (43.8)

3 (50.0)

4 (40.0)

1.000

RVSP (mm Hg)

30.3 ± 2.5

36.0 ± 5.1

28.0 ± 2.7

0.161

Type of surgery

0.088

PVR

1 (6.3)

0 (0.0)

1 (7.7)

PVR + TVR

16 (84.2)

4 (66.7)

12 (92.3)

PVR + TVR + AVR

2 (10.5)

2 (33.3)

0 (0.0)

Post-surgical mortality

2 (10.5)

1 (16.7)

1 (7.7)

1.000

Operative (30 days)

0 (0.0)

During 6-months follow up

2 (10.5)

1 (16.7)

1 (7.7)

1.000

**Table 2.** Characteristics of Patients With Carcinoid Heart Disease Who Required Post-Surgical Pacemaker Placement
Patient	Surgery	Year of surgery	Prior valve surgery	Reason for PPM	Time to PPM (days)	PPM type	PPM burden in several months
AVR: aortic valve replacement; CHB: complete heart block; NA: not available; PPM: permanent pacemaker: PVR: pulmonary valve replacement; TVR: tricuspid valve replacement; A: atrial; V: ventricular.
1	TVR, PVR	2012	Yes (TVR, PVR)	CHB	6	Dual-chamber	100% V-paced
2	TVR, PVR, AVR	2014	None	CHB	8	Dual-chamber	NA
3	TVR, PVR	2015	None	CHB	7	Dual-chamber	33% A-paced
4	TVR, PVR	2015	None	CHB	7	Dual-chamber	19% A-paced, 100% V-paced
5	TVR, PVR	2004	None	CHB	5	Dual-chamber	100% V-paced
6	TVR, PVR, AVR	2012	None	CHB	5	Dual-chamber	87% A-paced, 11% V-paced

Table 2. Characteristics of Patients With Carcinoid Heart Disease Who Required Post-Surgical Pacemaker Placement

Patient

Surgery

Year of surgery

Prior valve surgery

Reason for PPM

Time to PPM (days)

PPM type

PPM burden in several months

AVR: aortic valve replacement; CHB: complete heart block; NA: not available; PPM: permanent pacemaker: PVR: pulmonary valve replacement; TVR: tricuspid valve replacement; A: atrial; V: ventricular.

TVR, PVR

2012

Yes (TVR, PVR)

CHB

Dual-chamber

100% V-paced

TVR, PVR, AVR

2014

None

CHB

Dual-chamber

TVR, PVR

2015

None

CHB

Dual-chamber

33% A-paced

TVR, PVR

2015

None

CHB

Dual-chamber

19% A-paced, 100% V-paced

TVR, PVR

2004

None

CHB

Dual-chamber

100% V-paced

TVR, PVR, AVR

2012

None

CHB

Dual-chamber

87% A-paced, 11% V-paced