Abstract and Introduction
Abstract
Background: Patients over the age of 75 represent more than half the recipients of permanent pacemakers. It is not known if they have a different risk of complications than younger patients.
Methods: Patient-level data were pooled from the CTOPP, UKPACE, and Danish pacing trials. These three randomized trials of pacing mode systematically captured early and late complications following pacemaker insertion. Early postimplant complications included lead dislodgement or loss of capture, cardiac perforation, pneumothorax, hematoma, infection, and death. Lead fracture was considered a late complication.
Results: A total of 4,814 patients were included in this analysis, with an average follow-up of 5.1 years. The average age was 76 years and 43% were female. Any early complication occurred in 5.1% of patients ≥75 years of age compared to 3.4% of patients aged <75 years (P = 0.006). This was driven by an increased risk of pneumothorax (1.6% vs 0.8%, P = 0.07) and both atrial and ventricular lead dislodgement/loss of capture (2.0% vs 1.1%, P = 0.07). Early complications were higher in patients receiving atrial-based pacemakers in both age groups (<75 years: 4.6% vs 2.4%; ≥75 years: 6.6% vs 3.7%); however, the relative risk was not influenced by age group. Older patients had a lower risk of lead fracture (3.6% vs 2.7%, P = 0.08).
Conclusion: Elderly patients (≥75 years of age) are at increased risk of early postimplant complications but are at lower risk for lead fracture. PACE 2012; 35:131–134)
Introduction
Although pacemaker implantation is considered to be minor surgery, complications are common, with rates varying between 3.3% and 3.8% in large clinical trials.[1,2] A large proportion of patients receiving pacemakers are elderly and it has been well demonstrated for other surgeries that age is an independent risk factor for complications.[3,4] Since the elderly are such an important group of pacemaker recipients, it is important to understand if they are at increased risk of complications and if so, which ones. Although in most cases the decision to implant a pacemaker is not discretionary, the surgical approach could be altered if specific risks can be identified in this age group. The pooled database of randomized trials of pacing mode provides a large patient cohort in which to evaluate this issue.
Pacing Clin Electrophysiol. 2012;35(2):131-134. © 2012 Blackwell Publishing
