Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark

Rikke Esberg Kirkfeldt, Jens Brock Johansen, Ellen Aagaard Nohr, Ole Dan Jørgensen, Jens Cosedis Nielsen, Rikke Esberg Kirkfeldt, Jens Brock Johansen, Ellen Aagaard Nohr, Ole Dan Jørgensen, Jens Cosedis Nielsen

Abstract

Aims: Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient morbidity, healthcare costs, and possibly increased mortality.

Methods and results: Population-based cohort study in all Danish patients who underwent a CIED procedure from May 2010 to April 2011. Data on complications were gathered on review of all patient charts while baseline data were obtained from the Danish Pacemaker and ICD Register. Adjusted risk ratios (aRRs) with 95% confidence intervals were estimated using binary regression. The study population consisted of 5918 consecutive patients. A total of 562 patients (9.5%) experienced at least one complication. The risk of any complication was higher if the patient was a female (aRR 1.3; 1.1-1.6), underweight (aRR 1.5; 1.1-2.3), implanted in a centre with an annual volume <750 procedures (0-249 procedures: aRR 1.6; 1.1-2.2, 250-499: aRR 2.0; 1.6-2.7, 500-749: aRR 1.5; 1.2-1.8), received a dual-chamber ICD (aRR 2.0; 1.4-2.7) or CRT-D (aRR 2.6; 1.9-3.4), underwent system upgrade or lead revision (aRR 1.3; 1.0-1.7), had an operator with an annual volume <50 procedures (aRR 1.9; 1.4-2.6), or underwent an emergency, out-of-hours procedure (aRR 1.5; 1.0-2.3).

Conclusion: CIED complications are more frequent than generally acknowledged. Both patient- and procedure-related predictors may identify patients with a particularly high risk of complications. This information should be taken into account both in individual patient treatment and in the planning of future organization of CIED treatment.

Keywords: Cardiac resynchronization therapy; Complication; Implantable cardioverter defibrillator; Pacemaker; Predictors.

Figures

Figure 1
Figure 1
Risk of any complication according to procedure and CIED type (with 95% CI).
Figure 2
Figure 2
Predictors of any complication.

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