[Perioperative complications during transvenous pacemaker and defibrillator implantation]

Despite major advances in cardiovascular implantable electronic devices (CIEDs) and implantation techniques, perioperative complications remain clinically relevant. Reported rates of relevant complications after transvenous CIED implantation range from 2 to 11% and may adversely affect patient outcomes. Major complications include access-related vascular injuries, venous thrombosis, pneumothorax and hemothorax, and cardiac complications such as lead perforation or tricuspid valve dysfunction, lead dislodgement, unrecognized malposition of the right ventricular lead in the left ventricle, arrhythmias, pocket hematoma, and device-related infections. This article provides a structured overview of the most relevant perioperative complications associated with CIED implantation. Practical strategies for prevention, early detection, and appropriate management of these complications are also discussed. Given the increasing number of procedures, the growing complexity of device systems, and the rising proportion of multimorbid patients, meticulous procedural planning and strict adherence to preventive measures are essential to improve safety and clinical outcomes.