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Cardiac Implantable Electronic Device Complications and Mortality
Study Questions:
What is the impact of cardiac implantable electronic device (CIED) complications on all-cause and cardiovascular mortality?
Methods:
This was a prospective, six-center registry of patients undergoing de novo CIED implantation. Consecutive patients were followed up for ≥3 years. A complication was defined as any CIED-related adverse event requiring surgical revision after implantation.
Results:
The median follow-up was 57 months. From among 2,811 patients, 263 of them experienced 283 complications (10% complication rate). Early complications (≤30 days) were associated with significantly lower cumulative survival from cardiovascular death in comparison with no complications or late complications. On multivariate analysis, early complication, pneumothorax, and pocket hematoma were significantly associated with a higher risk of all-cause death, while device infection remained the only complication significantly associated with a higher risk of cardiovascular death.
Conclusions:
CIED-related complications are associated with an increased risk of cardiovascular mortality, and early complications are associated with an increased risk of all-cause mortality.
Perspective:
This manuscript shows that 1 in 10 patients status/post CIED implants experience a complication requiring reoperation. It furthermore suggests that even relatively “benign” types of complications such as pneumothorax and pocket hematoma are independently associated with increased all-cause mortality. This is probably because these complications are especially prevalent in frail patients. These data highlight the importance of measures aimed at reducing CIED complications and improving their management.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Cardiac Surgical Procedures, Defibrillators, Implantable, Frail Elderly, Heart Failure, Geriatrics, Hematoma, Infections, Pneumothorax, Reoperation, Secondary Prevention
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