TY - CHAP M1 - Book, Section TI - Pacemaker and Defibrillator Therapy in Cardiac Surgery Patients A1 - Sutton, Brad S. A1 - Bilchick, Kenneth C. A1 - Berger, Ronald D. A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. Y1 - 2014 N1 - T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - Pacemaker therapy effectively treats bradycardia-related symptoms for patients with sinus node dysfunction, advanced atrioventricular (AV) block, and in some instances carotid sinus hypersensitivity.Conduction disturbance after cardiac surgery is relatively common after coronary artery bypass grafting and valve surgery. Although the natural history of postoperative AV block is variable, the need for a permanent pacemaker (PPM) system is higher in those with preexisting electrocardiogram abnormalities, prolonged bypass time, and repeat procedures.Bradycardia after cardiac transplantation is usually temporary and far less common with bicaval anastomoses.In carefully selected heart failure patients, cardiac resynchronization therapy (CRT) has been shown to improve heart failure symptoms, quality of life, and reduce mortality.Several randomized clinical trials have demonstrated reduced infectious complications following permanent device implantation with empiric periprocedural antibiotic administration.When coronary sinus anatomy or pacing parameters prohibit transvenous lead placement for CRT, a number of techniques can be used to place epicardial leads. Robotic arm placement may reduce the amount of postoperative pain that patients experience.Optimal PPM therapy requires selection of appropriate pacemaker type and pacing mode for each patient.Pacemaker complications can be divided into those associated with the implantation procedure, subsequent infections, loss of lead integrity, and programming-related problems.Indications for device extraction include systemic infection, arrhythmia or other complications related to retained fragments or leads, and the need for additional vascular access.Implantable cardioverter-defibrillator therapy is indicated for patients with structural heart disease and life-threatening ventricular arrhythmias or risk factors for sudden death. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104592064 ER -