The Incidence of Reoperations in Pacemaker Recipients
DOI:
https://doi.org/10.1532/HSF98.20061057Abstract
Objective. To evaluate the incidence of reoperation due to complications or battery depletion in patients who underwent endocardial permanent pacemaker implantation during an 8-year period.
Methods. All pacemaker implantation and related procedures from January 1996 to June 2003 were retrospectively collected and entered into a database. During this time period a total number of 3856 operations with 2242 primary implantations and 1614 redo operations were performed at our department. As 809 patients were referred from another hospital, where the primary operation was done, these patients were excluded from further analysis. The mean follow-up time was 48 months, ranging from 6 to 96 months.
Results. A total of 547 patients underwent 805 reoperations during this 8-year period. The most common cause for reoperation was lead malfunction, which occurred in 326 patients (8.4%). Atrial leads were affected more commonly (206 patients, 63%) than ventricular leads (120 patients, 37%). Eighty percent of lead failure occurred during the first 3 months after implantation and was due to dislocation of the lead, whereas the remaining 20% occurred more than 3 months after implantation and were caused by lead fracture, insulation failure, and exit block. Elective replacement indication of a pacemaker was necessary in 312 patients (8%), and pacemaker pocket erosion or infection required reoperation in 167 patients (4%).
Conclusion. Permanent pacemaker implantation is now accepted as a highly effective and safe procedure. However, cost effectiveness and the relatively simple procedure have to be weighed against the need of reoperations due to system malfunction or replacement indication.
References
Aggarwal RK, Connely DT, Ray SG, et al. 1995. Early complications of permanent pacemaker implantation: difference between dual and single chamber systems. Br Heart J 73:571-5.nBrunner M, Oleschewsky M, Geibel A, et al. 2004. Long term survival after pacemaker implantation. Eur Heart J 25:88-95.nDaley WR. 1998. Factors associated with implantation of single versus dual chamber pacemakers in 1992. Am J Cardiol 82:392-5.nEllenbogen KA, Hellkamp AS, Wilkoff LB et al. 2003. Complications arising after implantation of DDD pacemakers: the MOST experience. Am J Cardiol 92:740-9.nEllenbogen KA, Wood MA, Shepard RK. 2002. Delayed complications following pacemaker implantation. PACE 25:1155-8.nHarcombe AA, Newell SA, Ludman PF, et al. 1998. Late complications following permanent pacemaker implantation or elective unit replacement. Heart 80:240-4.nHildick-Smith DJR, Lowe MD, Newell SA, et al. 1998. Ventricular pacemaker upgrade: experience, complications and recommendations. Heart 79:383-7.nKawanishi DT, Song S, Furman S, et al. Failure rates of leads, pulse generators, and programmers have not diminished over the last 20 years. PACE 19:1819-23.nKiviniemi MS, Pirnes MA, Eränen JK, et al. 1999. Complications related to permanent pacemaker therapy. PACE 22:711-20.nMoller M. 2002. The Danish pacemaker registry (DPR). University Hospital, Department of Cardiology, Odense Denmark; 12-3.nMontanez A, Hennekens CH, Zebede J, et al. 2003. Pacemaker mode selection: the evidence from randomized trials. PACE 26:1270-82.nStambler BS, Ellenbogen KA, Orav EJ, et al. 2003. Predictors and clinical impact of atrial fibrillation after pacemaker implantation in elderly patients treated with dual chamber versus ventricular pacing. PACE 26:2000-7.nSutton R, Bourgois I. 1996. Cost benefit analysis of single and dual chamber pacing for sick sinus syndrome and atrioventricular block. Eur Heart J 17:574-82.nTobin K, Stewart J, Westveer D, et al. 1999. Acute complications of permanent pacemaker implantation: their financial implication and relation to volume and operator experience. Am J Cardiol 85:774-6.nWiegand UKH, Bode F, Bonnemeier H, et al. 2003. Long term complication rates in ventricular, single lead VDD, and dual chamber pacing. PACE 26:1961-9.n
