Keywords
cardiac implantable electronic device (cied)
long-term care
postoperative complication
How to Cite
Abstract
Introduction: Cardiovascular implantable electronic devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are crucial for managing various cardiac conditions. However, their implantation is associated with a range of potential complications.
This article investigates the incidence, types, and risk factors of complications arising from CIED implantation.
Around 180.000 pacemakers are implanted every year in the USA [1]. Keeping in mind that pacemakers are implanted mainly in the elderly, the increasing proportion of this age group translates to a progressive increase in yearly implantations.
A review of pacemakers implanted in adults shows an age interval of 69-86 years old, with 30-40% of patients >80 years old [2,3].
In a case series article, 218 patients were included in those undergoing permanent pacemaker implantation in the UHC "Mother Theresa" Tirana.
Data were retrospectively collected from patients who underwent CIED implantation. The primary complications assessed included infection, lead dislodgement, device malfunction, hematoma, and vascular complications. Statistical analysis was performed to identify significant risk factors associated with these complications.
Conclusions: This article underscores the importance of meticulous procedural techniques, thorough patient assessment, and post-implantation monitoring to minimize the risks associated with CIED implantation. Enhanced understanding of these complications can lead to improved patient outcomes and the development of strategies to mitigate risks in clinical practice.
Keywords: permanent pacemaker implantation (ppm), cardiac implantable electronic device (cied), long-term care, postoperative complication
References
2. Rosenheck S, Geist M, Weiss A, Hasin Y, Weiss TA, Gotsman MS, “Permanent Cardiac Pacing in Octogenarians,” Amer J Ger Card, V. 4, No. 6 (1995), pp. 42-47.
3. Nowak B and Misselwitz B, “Effects of increasing age onto procedural parameters in pacemaker implantation: results of an obligatory external quality control program,” Europace, V. 11 (November 2008), pp. 75-79.
4. Ormir Shurdha , Endri Hasimi, Arkel Duka, Elona Çollaku, Ervina Shirka, Meriton Siqeca, Ela Petrela, Vilma Paparisto, Artan Goda, “"Profili i implantimit të pacemakerave në Qendrën Spitalore Universitare "Nënë Tereza, Tiranë”, Revista Shqiptare e Kardiologjise, Vellimi XII, nr 2, faqe 3, Nentor 2014
5. Parsonnet V, Bernstein AD, Lindsay B, “Pacemaker-Implantation Complication Rates: An Analysis of Some Contributing Factors,” JACC, V. 13, No. 4 (March 15, 1989), pp. 917-921.
6. Aggarwal RK, Connelly DT, Ray SG, Ball J, Charles RG, “Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems,” Br Heart J, V. 73 (1995), pp.571-575.
7. Wiegand UKH, Bode F, Bonnemeier H, Eberhard F, Schlei M, Peters W, “Long-Term Complication Rates in Ventricular, Single Lead VDD, and Dual Chamber Pacing,” PACE, V. 26 (October 2003), pp. 1961-1969
8. Belott P, “How to access the axillary vein,” Heart Rhythm, V. 3, No. 3 (March 2006), pp. 366-369.
9. Williams JL, Lugg D, Gray R, Hollis D, Stoner M, Stevenson R, “Patient Demographics, Complications, and Hospital Utilization in 250 Consecutive Device Implants of a New Community Hospital Electrophysiology Program,” American Heart Hospital Journal, V. 8, No. 1 (Summer, 2010), pp. 33-39
10. Hirschl DA, Jain VR, Spindola-Franco H, Gross JN, Haramati LB, “Prevalence and Characterization of Asymptomatic Pacemaker and ICD Lead Perforation on CT,” PACE, V. 30 (January 2007), pp. 28–32
11. Cappato R, Calkins H, Chen S-A, Davies W, Iesaka Y, Kalman J, Kim Y-H, Klein G, Natale A, Packer D, Skanes A, “Prevalence and Causes of Fatal Outcome in Catheter Ablation of Atrial Fibrillation,” JACC, Vol. 53, No. 19 (May 12, 2009), 1798–803.
12. Leon AR, Abraham WT, Curtis AB, et al.; for the MIRACLE Study Program, “Safety of Transvenous Cardiac Resynchronization System Implantation in Patients with Chronic Heart Failure: Combined Results of Over 2000 Patients from a Multicenter Study Program,” J Am Coll Cardiol, 2005;46(12):2348–56.
13. Knight BP, Desai A, Coman J, Faddis M, Yong P, “Long-term retention of cardiac resynchronization therapy,” JACC, V. 44, No. 1 (July 7, 2004), pp. 72-77
14. Nowak B and Misselwitz B, “Effects of increasing age onto procedural parameters in pacemaker implantation: results of an obligatory external quality control program,” Europace, V. 11 (November 2008), pp. 75-79
15. Schulza N, Puschelb K, Turkc EE, “Fatal complications of pacemaker and implantable cardioverter defibrillator implantation: medical malpractice? “ Interactive CardioVascular and Thoracic Surgery, V. 8 (2009), pp. 444–448
16. Wiegand UKH, LeJeune D, Boguschewski F, Bonnemeier H, Eberhardt F, Schunkert H, Bode F, “Pocket Hematoma After Pacemaker or Implantable Cardioverter Defibrillator Surgery: Influence of Patient Morbidity, Operation Strategy, and Perioperative Antiplatelet/Anticoagulation Therapy,” CHEST, V. 126, No. 4 (October 2004), pp. 1177-1186.
17. Ahmed I, Gertner E, Nelson WB, House CM, Dahiya R, Anderson CP, Benditt DG, Zhu DWX, “Continuing warfarin therapy is superior to interrupting warfarin with or without bridging anticoagulation therapy in patients undergoing pacemaker and defibrillator implantation,” Heart Rhythm, V. 7, No. 6 (June 2010), pp. 745-749.
18. Hargreaves MR, Doulalas A, Ormerod OJM, “Early Complications Following Dual Chamber Pacemaker Implantation: 10-Year Experience of a Regional Pacing Centre,” Eur JCPE, V. 5, No. 3 (1995), pp. 133-138
19. Kiviniemi MS, Pirnes MA, Eranen HJK, Kettunen RVJ, Hartikainen JEK,“Complications Related to Permanent Pacemaker Therapy,” PACE, V. 22 (May 1999), pp. 711-720.
20. Stevenson R, Lugg D, Gray R, Hollis D, Stoner M, Williams JL, “Pacemaker Implantation in the Extreme Elderly,” Journal of Interventional Cardiac Electrophysiology, V. 33, No. 1 (January 2012), pp. 51-58.
21. T. Fahraeus and C. J. Hoijer, “Early pacemaker twiddler syndrome,” Europace, Vol. 5 (July 2003), pp
22. Tarakji KG, Chan EJ, Cantillon DJ, Doonan AL, Hu T, Schmitt S, Fraser TG, Kim A, Gordon SM, Wilkoff BL et al, “Cardiac implantable electronic device infections: Presentation, management, and patient outcomes,” Heart Rhythm V. 7, No. 8 (August 2010), pp. 1043-104
23. Johansen JB, Jørgensen OD, Møller M, Arnsbo P, Mortensen PT, Nielsen JC, “Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients,” Eur Heart J, V. 32, No. 8 (April 2011) pp. 991–998
24. Nery PB, Fernandes R, Nair GM, Sumner GL, Ribas CS, Menon SM, Wang X, Krahn AD, Morillo CA, Connolly SJ, Healey JS, “Device-related infection among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences,” J Cardiovasc Electrophysiol, V. 21, No. 7 (July 2010), pp. 786-90.
25. Wilkoff BL, “How to treat and identify device infections,” Heart Rhythm, V. 4 (2007), pp. 1467–1470
26. Grammes JA, Schulze CM, Al-Bataineh M, Yesenosky GA, Saari CS, Vrabel MJ, Horrow J, Chowdhury M, Fontaine JM, Kutalek SP, “Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram,” J Am Coll Cardiol, V. 55, No. 9 (March 2010), pp. 886-94.
27. Oginosawa Y, Abe H, Nakashima Y, “The incidence and risk factors for venous obstruction after implantation of transvenous pacing leads,” Pacing Clin Electrophysiol, V. 25 (2002), pp. 1605-1611
28. Armaganijan LV, Toff WD, Nielsen JC, Andersen HR, Connolly SJ, Ellenbogen KA, Healey JS, “Are Elderly Patients at Increased Risk of Complications Following Pacemaker Implantation? A Meta-Analysis of Randomized Trials,” Pacing Clin Electrophysiol, Epub ahead of Print, (2011 Oct 31).
29. Czosek RJ, Meganathan K, Anderson JB, Knilans TK, Marino BS, Heaton PC,” Cardiac rhythm devices in the pediatric population: Utilization and complications,” Heart Rhythm, V. 9, No. 2 (Feb 2012), pp. 199-208
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