Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience
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Updated: Oct 2, 2025
Translational Rabbit Model of Chronic Cardiac Pacing
Published on: January 6, 2023
Anita Shirwaiker1, Jeremy William1, Justin A Mariani2
1Heart Centre, Alfred Health, Melbourne, Vic, Australia.
Insights
Pacemaker implantation in young adults carries significant long-term risks, including device complications and under-utilization. Careful consideration and close monitoring are essential for this patient group.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Long-term outcomes of pacemaker implantation in younger adults are not well-documented.
- This study addresses the limited literature on pacemaker use in patients aged 18-50.
Purpose of the Study:
- To evaluate the long-term implications of pacemaker insertion in younger adults.
- To identify risks and complications associated with pacemakers in this demographic.
Main Methods:
- Retrospective analysis of 81 patients (18-50 years) who received pacemakers between 1986-2020.
- Exclusion of defibrillators and cardiac resynchronization therapy devices.
- Review of clinical records, pacemaker checks, and echocardiograms for long-term follow-up.
Main Results:
- 11% of patients experienced late device-related complications (malfunction, infection).
- 17% showed ventricular function decline, with 11% requiring biventricular upgrade.
- 5% developed new tricuspid regurgitation; 19% had minimal pacemaker utilization.
Conclusions:
- Pacemaker insertion in younger adults has substantial long-term consequences.
- Risks include device complications, under-utilization, and lead longevity issues.
- Close patient follow-up is crucial for detecting structural abnormalities and arrhythmias.
Background:
The long-term implications of pacemaker insertion in younger adults are poorly described in the literature.
Methods:
We performed a retrospective analysis of consecutive younger adult patients (18-50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986-2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed.
Results:
Eighty-one (81) patients (median age 41.0 yrs IQR=35-47.0, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1-14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients.
Conclusions:
Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
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