الفهرس 
Development of the Cardiac Conduction SystemOnly 14 pages are availabe for public view
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Abstract
Background: Cardiac conduction abnormalities after heart surgery are observed. Although Transient bradyarrhythmia resolve themselves in the first days after surgery, but persistent conduction disturbances requiring permanent pacemaker implantation (PPI) occur in considerable number of patients undergoing conventional heart surgery. Aim of the Work: to investigate perioperative predictors of conducting system disorder after open heart surgery, indications and prevalence for permanent pacemaker implantation after open heart surgery. Patients and Methods: The present study was conducted on 134 adult patients who underwent various surgeries (open-heart surgery; all CABG operations, CABG and valve operations, valve only operations and other operations including modified Bentall’s procedure, excision of atrial myxomas, personalized external aortic root. All redo and emergency operations) at Ain Shams University Hospital, Cardiothoracic Surgery Department (cardiothoracic Academy) during 6 months. Results: we found that 32 patients (24%) had arrhythmia, like LBBB one patient (1%), RBBB 4 patients (5%), AF 14 patients (10%)and Complete heart block 11 patients (8%).with ICU follow up we found that PPM in our study were all post valve replacement, 4 patients with a PPM implanted postoperatively underwent aortic valve replacement either as a stand-alone procedure or in conjunction with other cardiac surgical procedures for pathology like HOCM, Aortic root abscess, Aortic ANNURYSIM and sever calcific aortic stenoses. That may be related to the extra surgery itself or the time consumed to do so in the AVR surgeries, two of them were Mitral valve replacement both with Sorin metallic valve and one patient after discharge from hospital through reqular follow up. Conclusion: The incidence of severe postoperative bradyarrhythmia after cardiac surgery requiring permanent pace maker insertion was 5% and varies with type of surgery, more common with valve replacement mostly due to trauma to the conduction system.