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Trends in the 30-year span of Noninfectious Cardiovascular Implantable Electronic Device Complications in Olmsted
Gurukripa N Kowlgi1, Vaibhav Vaidya1, Ming-Yan Dai1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Cardiovascular implantable electronic device (CIED) complications, like lead dislodgement and hematoma, decreased in the last decade due to improved practices. This trend offers valuable real-world data on CIED safety over 30 years.
Area of Science:
- Cardiology
- Biomedical Engineering
- Public Health
Background:
- Cardiovascular implantable electronic devices (CIEDs) are crucial for managing various heart conditions.
- Real-world data on CIED complications and their trends remain limited.
Conclusions:
- The study provides real-world insights into CIED complication trends over 30 years.
- A significant decline in complications in the last decade is attributed to safer practices and improved anticoagulant management.
- Lead dislodgements and hematomas remain the primary CIED complications requiring attention.
Background:
Cardiovascular implantable electronic devices (CIEDs) such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends.
Objectives:
Describe trends in noninfectious CIED complications over the past three decades in Olmsted County.
Methods:
The Rochester Epidemiology Project is a medical records linkage system comprising records of over 500,000 residents of Olmsted County from 1966-current. CIED implants between 1988-2018 were determined. Trends in noninfectious complications within 30 days of implant were analyzed.
Results:
175 out of 2536 (6.9%) patients who received CIED experienced device complications. 3.8% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.9%), followed by hematoma (2.1%). Complications went up from 1988 to 2005, then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (p<0.01). Those with complications were more likely to have prosthetic valves. Obesity appeared to have a protective effect in a multivariate regression model. The mean Charlson comorbidity score has trended up over the 30 years.
Conclusions:
Our study describes a real-world trend of CIED complications over three decades. Lead dislodgements and hematomas were the most common complications. Complications have declined over the last decade due to safer practices and a better understanding of anticoagulant management.
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