A nationwide Swedish registry cohort followed 76 223 adults without a prior cardiac device who underwent cardiac surgery between 2006 and 2020. Permanent pacemaker implantation within 30 days, occurring in 2.8%, was associated with all-cause mortality (adjusted HR 1.09, 95% CI 1.01-1.19) and heart failure hospitalisation (aHR 1.36, 95% CI 1.22-1.52) over a mean 6.8 years; cardiovascular mortality moved in the same direction but was not statistically significant. ICD implantation, in 0.5%, was associated with heart failure hospitalisation and cardiovascular mortality but not all-cause mortality.
Why it is interesting: Settles a contradictory literature on whether perioperative conduction damage carries a lasting mortality signal, using complete national follow-up rather than single-centre series.