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International Journal of Angiology

, Volume 5, Issue 2, pp 78–81 | Cite as

Acute and early complications of permanent pacing: A prospective audit of 926 consecutive patients from a UK center

  • Rajesh K. Aggarwal
  • Derek T. Connelly
  • Simon G. Ray
  • Richard G. Charles
Original Articles
  • 22 Downloads

Abstract

To evaluate the incidence of intraoperative and early postoperative complications (up to 2 months after implant) of endocardial permanent pacemaker insertion in all patients undergoing their first implant at our Center, we prospectively evaluated all pacemaker implantation procedures performed from April 1992 to September 1993. A standard “audit” form was completed at implant, recording patient demographic data, medical history, details of pacemaker hardware used, and any acute complications. Follow-up information was also collected prospectively onto standard forms at the pacemaker outpatient clinic. The study was performed in a United Kingdom tertiary referral Cardiothoracic Center. Nine hundred and fifty consecutive patients underwent implantation of their first endocardial permanent pacemaker from April 1992 to September 1993. Implant and follow-up data to 2 months were available on 926 (97.5%) of these patients at analysis, 51.4% were male (median age 77 years; range 16–99). Dual chamber units were implanted in 53% of patients, single chamber atrial in 6%, and ventricular in 41%. At implant, 23% of patients had a temporary pacing leadin situ. Most (93%) implants were performed via the subclavian vein. Acute complications were rare: 9 patients developed pneumothorax requiring medical treatment and 10 patients developed an insignificant pneumothorax. Arterial puncture without sequelae was documented in 2.7% of attempts at subclavian vein cannulation. Complications requiring re-operation occurred in 3.5% of patients overall; lead displacement [n=14 patients (1.5%)] was the most common reason for re-operation. Atrial lead displacement [n=10 patients (1.85% of atrial leads)] was significantly more common than ventricular lead displacement [n=4 patients (0.46% of ventricular leads),p=0.02]. Pacemaker pocket infection led to reoperation in 9 patients (0.97%) and was significantly more common in patients with a temporary pacing lead at implant (2.35%) compared with those without (0.56%,p<0.05). Five patients (0.5%) required re-operation for generator erosion and a further 5 (0.5%) for drainage of hematoma or a serous fluid collection. Complications that did not require re-operation occurred in 2.4% of patients overall: atrial (n =8) and ventricular (n=1) undersensing was successfully treated by reprogramming of sensitivity in all cases. Superficial wound infection was treated successfully with antibiotics in eight patients. Six patients with DDD generators developed atrial fibrillation: one was cardioverted, two required reprogramming to VVI mode, and three reverted spontaneously to sinus rhythm. In summary, permanent pacing in a large tertiary referral center with experienced operators carries a low risk. Infection rates are low (<1%). Lead displacement and undersensing are more likely to occur with atrial than with ventricular leads. The overall complication rate for dual chamber pacing is no higher than for single chamber pacing.

Keywords

Subclavian Vein Dual Chamber Single Chamber Ventricular Lead Temporary Pace 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Elmqvist R, Senning A (1959) An implantable pacemaker for the heart. In: Medical Electronics, Smyth CN (eds). Proc 2nd Intl Conf on Medical Electronics. Illife, London; p 253.Google Scholar
  2. 2.
    Clarke M, Sutton R, Ward D, Camm AJ, Rickards A, Ingram A, Perrins EJ, Charles R, Jones S, Cobbe S (1991) Recommendations for pacemaker prescription for symptomatic bradycardia. Report of a working party of the British Pacing and Electrophysiology Group. Br Heart J 66:185–191.PubMedGoogle Scholar
  3. 3.
    de Belder MA, Linker NJ, Jones S, Camm AJ, Ward DE (1992) Cost implications of the British Pacing and Electrophysiology Group's recommendations for pacing. Br Med J 305:861–865.Google Scholar
  4. 4.
    Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, Petch MC (1994) Early complications after dual chamber versus single chamber pacemaker implantation (abstract). Br Heart J 71(5):59.Google Scholar
  5. 5.
    Parsonnet V, Bernstein AD, Lindsay B (1989) Pacemaker-implantation complication rates: An analysis of some contributing factors. J Am Coll Cardiol 13(4):917–921.PubMedGoogle Scholar
  6. 6.
    Morse D, Yankaskas M, Johnson B, et al. (1983) Transvenous pacemaker insertion with zero dislodgement rate. PACE 6:283.PubMedGoogle Scholar
  7. 7.
    Snow N (1982) Elimination of lead dislodgement by the use of tined transvenous electrodes. PACE 5:571.PubMedGoogle Scholar
  8. 8.
    Petch MC (1993) Who needs dual chamber pacing? Br Med J 307:215–216.Google Scholar
  9. 9.
    Channon KM, Cripps T, Ormerod O (1992) Recommendations for pacing (letter). Br Med J 305:1431–1432.Google Scholar
  10. 10.
    Mueller X, Sadeghi H, Kappenberger L (1990) Complications after single versus dual chamber pacemaker implantation. PACE 13:711–714.PubMedGoogle Scholar
  11. 11.
    Miller GB, Leman PB, Kratz JM, Gillette PC (1988) Comparison of lead dislodgement and pocket infection rates after pacemaker implantation in the operating room versus the catheterisation laboratory. Am Heart J 115:1048.CrossRefPubMedGoogle Scholar
  12. 12.
    Hess DS, Gertz WE, Morady F, Scheinman M, Sudduth BK (1982) Permanent pacemaker implantation in the cardiac catheterisation laboratory: The subclavian vein approach. Cath Cardiovasc Diagn 8:453.Google Scholar
  13. 13.
    Phibbs B, Marriott HJL (1985) Complications of permanent transvenous pacing. N Engl J Med 22:1428–1432.Google Scholar
  14. 14.
    Mounsey JP, Griffith MJ, Gold RG, Bexton RS (1994) Antibiotic prophylaxis reduces re-operation rate for infective complications following permanent pacemaker implantation: A prospective randomised trial (abstract). Br Heart J 71(5):70.PubMedGoogle Scholar
  15. 15.
    Ramsdale DR, Charles RG, Rowlands DB, Singh SS, Gautman PC, Faragher EB (1984) Antibiotic prophylaxis for pacemaker implantation: A prospective randomised trial. PACE 7:844–849.PubMedGoogle Scholar

Copyright information

© International College of Angiology, Inc. 1996

Authors and Affiliations

  • Rajesh K. Aggarwal
    • 1
  • Derek T. Connelly
    • 1
  • Simon G. Ray
    • 1
  • Richard G. Charles
    • 1
  1. 1.The Cardiothoracic CentreLiverpoolUK

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