The incidence of reoperations in pacemaker recipients

To evaluate the incidence of reoperation due to complications or battery depletion in patients who underwent endocardial permanent pacemaker implantation during an 8-year period.

All pacemaker implantation and related procedures from January 1996 to June 2003 were retrospectively collected and entered into a database. During this time period a total number of 3856 operations with 2242 primary implantations and 1614 redo operations were performed at our department. As 809 patients were referred from another hospital, where the primary operation was done, these patients were excluded from further analysis. The mean follow-up time was 48 months, ranging from 6 to 96 months.

A total of 547 patients underwent 805 reoperations during this 8-year period. The most common cause for reoperation was lead malfunction, which occurred in 326 patients (8.4%). Atrial leads were affected more commonly (206 patients, 63%) than ventricular leads (120 patients, 37%). Eighty percent of lead failure occurred during the first 3 months after implantation and was due to dislocation of the lead, whereas the remaining 20% occurred more than 3 months after implantation and were caused by lead fracture, insulation failure, and exit block. Elective replacement indication of a pacemaker was necessary in 312 patients (8%), and pacemaker pocket erosion or infection required reoperation in 167 patients (4%).

Permanent pacemaker implantation is now accepted as a highly effective and safe procedure. However, cost effectiveness and the relatively simple procedure have to be weighed against the need of reoperations due to system malfunction or replacement indication.