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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, Minnesota.
Insights
Cardiac implantable electronic device (CIED) complications, including lead dislodgement and hematoma, decreased in the last decade. This trend is attributed to improved practices and anticoagulant management, enhancing patient safety.
Area of Science:
- Cardiology
- Biomedical Engineering
- Public Health
Background:
- Cardiac implantable electronic devices (CIEDs) are crucial for managing cardiovascular diseases.
- Real-world data on CIED complications and their trends are limited.
Purpose of the Study:
- To analyze trends in noninfectious CIED complications over three decades.
- To identify common complications and factors associated with their occurrence.
Main Methods:
- Utilized the Rochester Epidemiology Project, a comprehensive medical records linkage system.
- Analyzed CIED implantations and noninfectious complications within 30 days from 1988 to 2018.
Main Results:
- 6.2% of 2536 patients experienced CIED complications; 2.7% had major complications.
- Lead dislodgement (2.8%) and hematoma (1.7%) were most frequent.
- Complications initially rose, then declined from 2005-2018, driven by fewer hematomas.
Conclusions:
- CIED complications, particularly lead dislodgement and hematoma, have shown a downtrend in the last decade.
- Safer implantation practices and better anticoagulant management contribute to this decline.
- Increased comorbidity burden was observed over the study period.
Background:
Cardiac 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:
We sought to describe trends in noninfectious CIED complications over the past 3 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 to present. CIED implantations between 1988 and 2018 were determined. Trends in noninfectious complications within 30 days of implantation were analyzed.
Results:
A total of 157 (6.2%) of 2536 patients who received CIED experienced device complications. A total of 2.7% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.8%), followed by hematoma (1.7%). Complications went up from 1988 to 2005, and then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (P < .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 index has trended up over the 30 years.
Conclusion:
Our study describes a real-world trend of CIED complications over 3 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.
