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Volume 14
Issue 23
10.3390/jcm14238291
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Atrial Functional Mitral Regurgitation Is a Risk Factor for Permanent Pacemaker Implantation

by
Kyungsub Song
1,*,
YoHan Bae
1,
Jung Uk Woo
2,
Sungsil Yoon
1,
Hee Jeong Lee
3,
Woo Sung Jang
1,
Yun Seok Kim
1 and
Jonghoon Yoo
4
1
Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea
2
Medical Course, School of Medicine, Keimyung University College of Medicine, Daegu 42601, Republic of Korea
3
Department of Cardiology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Republic of Korea
4
Department of Emergency Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(23), 8291; https://doi.org/10.3390/jcm14238291
Submission received: 4 November 2025 / Revised: 13 November 2025 / Accepted: 19 November 2025 / Published: 21 November 2025
(This article belongs to the Special Issue Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions)
Versions Notes

Abstract

Background and Objectives: This study aimed to investigate risk factors for permanent pacemaker (PPM) implantation following the Maze procedure in patients with atrial functional mitral regurgitation (AFMR). Methods: A retrospective cohort of 423 patients who underwent the Maze procedure for persistent or paroxysmal atrial fibrillation from 2010 to 2025 was analyzed. Patients were categorized on the basis of the need for PPM postoperatively. Risk factors and rhythm outcomes were compared using multivariable Cox and logistic regression with backward stepwise selection according to the Akaike Information Criterion. Results: Forty-five patients (10.6%) required PPM implantation following the Maze procedure. The PPM group demonstrated a significantly higher AFMR prevalence than the non-PPM group (28.9% vs. 10.4%, p = 0.001). Preoperative fine P waves and older age were additional significant predictors. The PPM group exhibited lower postoperative sinus rhythm rates and higher junctional rhythm rates. AFMR (hazard ratio [HR], 2.10; p = 0.030), fine P wave (HR, 2.03; p = 0.049), and age (HR, 1.04; p = 0.018) independently predicted PPM implantation. AFMR particularly elevated the late PPM implantation risk. Conclusions: AFMR is an independent risk factor for late nodal dysfunction requiring PPM following Maze procedures. To detect delayed pacemaker requirements postoperatively, extended monitoring is recommended for patients with AFMR.
Keywords: mitral valve insufficiency; atrial fibrillation; Maze procedure; permanent pacemaker mitral valve insufficiency; atrial fibrillation; Maze procedure; permanent pacemaker

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MDPI and ACS Style

Song, K.; Bae, Y.; Woo, J.U.; Yoon, S.; Lee, H.J.; Jang, W.S.; Kim, Y.S.; Yoo, J. Atrial Functional Mitral Regurgitation Is a Risk Factor for Permanent Pacemaker Implantation. J. Clin. Med. 2025, 14, 8291. https://doi.org/10.3390/jcm14238291

AMA Style

Song K, Bae Y, Woo JU, Yoon S, Lee HJ, Jang WS, Kim YS, Yoo J. Atrial Functional Mitral Regurgitation Is a Risk Factor for Permanent Pacemaker Implantation. Journal of Clinical Medicine. 2025; 14(23):8291. https://doi.org/10.3390/jcm14238291

Chicago/Turabian Style

Song, Kyungsub, YoHan Bae, Jung Uk Woo, Sungsil Yoon, Hee Jeong Lee, Woo Sung Jang, Yun Seok Kim, and Jonghoon Yoo. 2025. "Atrial Functional Mitral Regurgitation Is a Risk Factor for Permanent Pacemaker Implantation" Journal of Clinical Medicine 14, no. 23: 8291. https://doi.org/10.3390/jcm14238291

APA Style

Song, K., Bae, Y., Woo, J. U., Yoon, S., Lee, H. J., Jang, W. S., Kim, Y. S., & Yoo, J. (2025). Atrial Functional Mitral Regurgitation Is a Risk Factor for Permanent Pacemaker Implantation. Journal of Clinical Medicine, 14(23), 8291. https://doi.org/10.3390/jcm14238291

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