{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:54:46Z","timestamp":1753876486939,"version":"3.41.2"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T00:00:00Z","timestamp":1691107200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>For bradycardic patients after cardiac surgery, it is unknown how long to wait before implanting a permanent pacemaker (PPM). Current recommendations vary and are based on observational studies. This study aims to examine why this variation may exist.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We conducted first a study of patients in our institution and second a systematic review of studies examining conduction disturbance and pacing after cardiac surgery. Of 5849 operations over a 6-year period, 103 (1.8%) patients required PPM implantation. Only pacing dependence at implant and time from surgery to implant were associated with 30-day pacing dependence. The only predictor of regression of pacing dependence was time from surgery to implant. We then applied the conventional procedure of receiver operating characteristic (ROC) analysis, seeking an optimal time point for decision-making. This suggested the optimal waiting time was 12.5 days for predicting pacing dependence at 30 days for all patients (area under the ROC curve (AUC) 0.620, P = 0.031) and for predicting regression of pacing dependence in patients who were pacing-dependent at implant (AUC 0.769, P &amp;lt; 0.001). However, our systematic review showed that recommended optimal decision-making time points were strongly correlated with the average implant time point of those individual studies (R = 0.96, P &amp;lt; 0.001). We further conducted modelling which revealed that in any such study, the ROC method is strongly biased to indicate a value near to the median time to implant as optimal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>When commonly used automated statistical methods are applied to observational data with the aim of defining the optimal time to pacing after cardiac surgery, the suggested answer is likely to be similar to the average time to pacing in that cohort.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euad238","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T20:19:05Z","timestamp":1691007545000},"source":"Crossref","is-referenced-by-count":4,"title":["How robust are recommended waiting times to pacing after cardiac surgery that are derived from observational data?"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8199-4275","authenticated-orcid":false,"given":"Alexander","family":"Tindale","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London , London W12 0HS , UK"},{"name":"Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2498-625X","authenticated-orcid":false,"given":"Ioana","family":"Cretu","sequence":"additional","affiliation":[{"name":"College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane , Uxbridge UB8 3PH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4486-4455","authenticated-orcid":false,"given":"Ross","family":"Haynes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9447-7789","authenticated-orcid":false,"given":"Naomi","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-3141","authenticated-orcid":false,"given":"Sunil","family":"Bhudia","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9650-5358","authenticated-orcid":false,"given":"Rebecca","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9742-3250","authenticated-orcid":false,"given":"Mark J","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust , Hill End Road, London UB9 6JH , UK"},{"name":"College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane , Uxbridge UB8 3PH , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3410-0814","authenticated-orcid":false,"given":"Darrel P","family":"Francis","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London , London W12 0HS , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"key":"2023081613224227300_euad238-B1","doi-asserted-by":"crossref","first-page":"e0140340","DOI":"10.1371\/journal.pone.0140340","article-title":"Pacemaker dependency after cardiac surgery: a systematic review of current evidence","volume":"10","author":"Steyers","year":"2015","journal-title":"PLoS One"},{"key":"2023081613224227300_euad238-B2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/j.1540-8159.2009.02170.x","article-title":"Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up","volume":"32","author":"Merin","year":"2009","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023081613224227300_euad238-B3","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0002-9149(00)01448-X","article-title":"Complete atrioventricular block after valvular heart surgery and the timing of pacemaker implantation","volume":"87","author":"Kim","year":"2001","journal-title":"Am J Cardiol"},{"key":"2023081613224227300_euad238-B4","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1093\/icvts\/ivs555","article-title":"Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time?","volume":"16","author":"Baraki","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023081613224227300_euad238-B5","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.jtcvs.2020.01.082","article-title":"Permanent pacemaker implantation after cardiac surgery: optimization of the decision making process","volume":"162","author":"Bis","year":"2021","journal-title":"J Thorac 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experience","volume":"23","author":"Waddingham","year":"2021","journal-title":"Europace"},{"key":"2023081613224227300_euad238-B12","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1111\/j.1540-8159.2009.02552.x","article-title":"Permanent pacemaker implantation following aortic valve replacement: current prevalence and clinical predictors","volume":"32","author":"Huynh","year":"2009","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023081613224227300_euad238-B13","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/14017431.2019.1698761","article-title":"Immediate and long-term need for permanent cardiac pacing following aortic valve replacement","volume":"54","author":"Viktorsson","year":"2020","journal-title":"Scand Cardiovasc J"},{"key":"2023081613224227300_euad238-B14","doi-asserted-by":"crossref","first-page":"e81699","DOI":"10.1371\/journal.pone.0081699","article-title":"Do optimal prognostic thresholds in continuous physiological variables really 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Analysis of origin of apparent thresholds, with systematic review for peak oxygen consumption, ejection fraction and BNP","volume":"9","author":"Giannoni","year":"2014","journal-title":"PLoS One"},{"key":"2023081613224227300_euad238-B15","first-page":"1335","article-title":"Incidence, indications, risk factors, and survival of patients undergoing cardiac implantable electronic device implantation after open heart surgery","volume":"19","author":"Wiggins","year":"2017","journal-title":"Europace"},{"key":"2023081613224227300_euad238-B16","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.hrthm.2023.01.013","article-title":"Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study","volume":"20","author":"Massoulli\u00e9","year":"2023","journal-title":"Heart Rhythm"}],"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euad238\/51037285\/euad238.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/25\/9\/euad238\/51116466\/euad238.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/25\/9\/euad238\/51116466\/euad238.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T13:22:57Z","timestamp":1692192177000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/doi\/10.1093\/europace\/euad238\/7237021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,2]]},"references-count":16,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,8,2]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euad238","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"type":"print","value":"1099-5129"},{"type":"electronic","value":"1532-2092"}],"subject":[],"published-other":{"date-parts":[[2023,9]]},"published":{"date-parts":[[2023,8,2]]},"article-number":"euad238"}}