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Are elderly patients at increased risk of complications following pacemaker implantation? A meta-analysis of
Luciana V Armaganijan1, William D Toff, Jens C Nielsen
1Electrophysiology and Clinical Arrhythmias, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
Insights
Elderly patients (≥75) face higher early pacemaker complications, including pneumothorax and lead issues. However, older individuals experience fewer late lead fractures compared to younger patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Device Research
Background:
- Over 75s constitute over half of permanent pacemaker recipients.
- Complication risks in elderly pacemaker patients remain unclear.
Purpose of the Study:
- To investigate age-related differences in permanent pacemaker complications.
- To compare early and late complication rates between patients ≥75 and <75 years old.
Main Methods:
- Pooled patient-level data from CTOPP, UKPACE, and Danish pacing trials.
- Systematic capture of early (lead dislodgement, perforation, pneumothorax, hematoma, infection, death) and late (lead fracture) complications.
- Analysis of 4,814 patients with an average follow-up of 5.1 years.
Main Results:
- Patients ≥75 had higher early complication rates (5.1% vs 3.4%, P=0.006), notably pneumothorax and lead dislodgement/loss of capture.
- While early complications were higher with atrial-based pacemakers in both age groups, age did not influence the relative risk.
- Older patients demonstrated a lower risk of lead fracture (3.6% vs 2.7%, P=0.08).
Conclusions:
- Elderly patients (≥75) face an elevated risk of early post-implant pacemaker complications.
- Conversely, older individuals exhibit a reduced risk of lead fracture, a late complication.
Background:
Patients over the age of 75 represent more than half the recipients of permanent pacemakers. It is not known if they have a different risk of complications than younger patients.
Methods:
Patient-level data were pooled from the CTOPP, UKPACE, and Danish pacing trials. These three randomized trials of pacing mode systematically captured early and late complications following pacemaker insertion. Early postimplant complications included lead dislodgement or loss of capture, cardiac perforation, pneumothorax, hematoma, infection, and death. Lead fracture was considered a late complication.
Results:
A total of 4,814 patients were included in this analysis, with an average follow-up of 5.1 years. The average age was 76 years and 43% were female. Any early complication occurred in 5.1% of patients ≥75 years of age compared to 3.4% of patients aged <75 years (P = 0.006). This was driven by an increased risk of pneumothorax (1.6% vs 0.8%, P = 0.07) and both atrial and ventricular lead dislodgement/loss of capture (2.0% vs 1.1%, P = 0.07). Early complications were higher in patients receiving atrial-based pacemakers in both age groups (<75 years: 4.6% vs 2.4%; ≥75 years: 6.6% vs 3.7%); however, the relative risk was not influenced by age group. Older patients had a lower risk of lead fracture (3.6% vs 2.7%, P = 0.08).
Conclusion:
Elderly patients (≥75 years of age) are at increased risk of early postimplant complications but are at lower risk for lead fracture.
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