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Trends in cardiac implantable electronic device utilization in adults with congenital heart disease: a US nationwide analysis

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Abstract

Background

Adults with congenital heart disease (ACHD) have increased risk of arrhythmias warranting implantation of cardiac implantable electronic devices (CIEDs), which may parallel the observed increase in survival of ACHD patients over the past few decades. We sought to characterize the trends and outcomes of CIED implantation in the inpatient ACHD population across US from 2005 to 2019.

Methods

A retrospective analysis of the Nationwide Inpatient Sample (NIS) identified 1,599,519 unique inpatient ACHD admissions (stratified as simple (85.1%), moderate (11.5%), and complex (3.4%)) using the International Classification of Diseases 9/10-CM codes. Hospitalizations for CIED implantation (pacemaker, ICD, CRT-p/CRT-d) were identified and the trends analyzed using regression analysis (2-tailed p < 0.05 was considered significant).

Results

A significant decrease in the hospitalizations for CIED implantation across the study period [3.3 (2.9–3.8)% in 2005 vs 2.4 (2.1–2.6)% in 2019, p < 0.001] was observed across all types of devices and CHD severities. Pacemaker implantation increased with each age decade, whereas ICD implantation rates decreased over 70 years of age. Complex ACHD patients receiving CIED were younger with a lower prevalence of age-related comorbidities, however, had a greater prevalence of atrial/ventricular tachyarrhythmias and complete heart block. The observed inpatient mortality rate was 1.2%.

Conclusions

In a nationwide analysis, we report a significant decline in CIED implantation between 2005 and 2019 in ACHD patients. This may either be due to a greater proportion of hospitalizations resulting from other complications of ACHD or reflect a declining need for CIED due to advances in medical/surgical therapies. Future prospective studies are needed to elucidate this trend further.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Jaideep Singh Bhalla, Abhishek J. Deshmukh, Heidi M. Connolly, Alexander C. Egbe, William R. Miranda & Malini Madhavan

  2. Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Monil Majmundar

  3. Department of Cardiovascular Medicine, West Virginia University Hospital, Morgantown, WV, USA

    Kunal N. Patel

  4. Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA

    Anca Chirac

Authors
  1. Jaideep Singh Bhalla
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  2. Monil Majmundar
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  3. Kunal N. Patel
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  4. Abhishek J. Deshmukh
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  5. Heidi M. Connolly
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  7. Alexander C. Egbe
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  8. William R. Miranda
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  9. Malini Madhavan
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Contributions

Jaideep S. Bhalla: investigation, data curation, writing: original draft preparation; Monil Majmundar: conceptualization, methodology, formal analysis; Abhishek J. Deshmukh: validation, supervision; Heidi M. Connolly: writing: review and editing; Anca Chirac: data curation, writing: review and editing; Alexander C. Egbe: writing: review and editing; William R. Miranda: writing: review and editing, supervision; Malini Madhavan: conceptualization, validation, writing: review and editing.

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Correspondence to Jaideep Singh Bhalla.

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Bhalla, J.S., Majmundar, M., Patel, K.N. et al. Trends in cardiac implantable electronic device utilization in adults with congenital heart disease: a US nationwide analysis. J Interv Card Electrophysiol 67, 319–328 (2024). https://doi.org/10.1007/s10840-023-01601-0

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  • DOI: https://doi.org/10.1007/s10840-023-01601-0

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