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Late complications following permanent pacemaker implantation or elective unit replacement
A A Harcombe1, S A Newell, P F Ludman
1Regional Cardiac Unit, Papworth Hospital NHS Trust, Cambridge, UK.
Insights
Late complications after permanent pacemaker implantation are infrequent, especially for initial procedures. Elective unit replacement carries a higher risk, with erosion and infection being the most common issues.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Complications
Background:
- Permanent pacemaker systems are crucial for managing cardiac arrhythmias.
- Understanding late complication rates is essential for patient safety and device management.
Purpose of the Study:
- To determine the incidence of late complications following initial permanent pacemaker implantation versus elective unit replacement.
- To identify common types and risk factors for late pacemaker complications.
Main Methods:
- Retrospective analysis of prospectively acquired pacemaker data from 2621 patients over an 11-year period (1984-1994).
- Complications were defined as those requiring repeat procedures more than six weeks post-implantation or replacement.
- Data were collected from a tertiary referral cardiothoracic centre.
Main Results:
- The overall late complication rate was significantly lower after first pacemaker implantation (1.4%) compared to elective unit replacement (6.5%).
- Common late complications included erosion (20 cases), infection (18 cases), electrode problems (5 cases), and miscellaneous issues (7 cases).
- Complication rates were substantially higher with inexperienced operators (18.9%) than experienced ones (0.9%).
Conclusions:
- Late complications following permanent pacemaker implantation are generally low and comparable to early complication rates.
- Erosion and infection represent the majority of late pacemaker complications.
- Patients undergoing elective unit replacement face a notably higher risk of late complications.
Objective:
To determine the rate of late complications following first implantation or elective unit replacement of a permanent pacemaker system.
Design:
Analysis of pacemaker data and complications prospectively acquired on a computerised database. Complications were studied over an 11 year period from January 1984 to December 1994.
Setting:
Tertiary referral cardiothoracic centre.
Patients:
Records of 2621 patients were analysed retrospectively.
Main Outcome Measures:
Complications requiring repeat procedures occurring more than six weeks after pacemaker implantation or elective unit replacement.
Results:
The overall rate of late complications was significantly lower after first implantation of a permanent pacemaker (34 cases, complication rate 1.4%, 95% confidence interval 0.9% to 1.9%) than after elective unit replacement (16 cases, complication rate 6.5% (3.3% to 9.7%). There were 20 cases of erosion, 18 infections, five electrode problems, and seven miscellaneous problems. Complications were more common with inexperienced operators (18.9% (6.0% to 31.8%)) than with experienced operators (0.9% (0.3% to 1.5%).
Conclusions:
The incidence of late complications following pacemaker implantation is low and compares favourably with early complication rates. The majority are caused by erosion and infection. Patients who have undergone elective unit replacement are at particular risk.