Methods: Forty-three of patients, who were operated within the last 10 years in our clinic, required PP implantation. Thirteen (30%), (10 males, 3 females; mean age 66.8±8.1; range 43 to 77 years) of these were operated for coronary artery disease (CAD), 24 (55%), (10 males, 14 females; mean age 52.5±5.6; range 16 to 73 years) for acquired valvular heart disease (AVD) and 6 (13%), (5 males, 1 female; mean age 11.1±10.8; range 3 to 32 years) for congenital heart disease. Eight of the CAD patients had AV block preoperatively. Nineteen of these patients had aortic valve replacement (AVR), 2 had reoperation for mitral valve replacement (MVR), 2 had AVR + MVR and 1 had MVR and CABG. Indications for PP implantation were; persistent complete AV block lasting for 10 days postoperatively, atrial fibrillation/ flutter with slow ventricular response leading to hemodynamic compromise and paroxysmal atrial fibrillation leading to sinusoidal arrest >3 seconds.

Results: PP implantation was required for persistence of preoperatively existing complete A-V block in 8 patients and for the new onset A-V block in 35 patients. Mean interval from operation to implantation was 10.8±4.3 days. Mean times of intensive care unit stay and hospital stay were 42.6±14.6 hours and 16.8±4.7 days respectively. Mean follow- up time was 23.1±18.3 months. In long term, one patient had pace-maker battery protrusion, one had pulmonary arterial thromboembolism. During follow-up, 36 patients were in NYHA (New York Heart Association) Class I, 5 were Class II.

Conclusion: Preoperative estimation of conduction defects may effect the surgical plan directly. Detailed risk scoring systems are essential to guide the surgical team. In long term follow-up, permanent pacemaker implantation does not affect the functional capacity adversely.