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Cardiac Tamponade Trends for Pacemaker Recipients
Study Questions:
What were the trends and predictors of cardiac tamponade among permanent pacemaker (PPM) recipients in the United States between 2008 and 2012?
Methods:
The authors analyzed the National Inpatient Sample (NIS) database to identify patients with PPMs and their comorbidities.
Results:
Among 922,549 patients who received PPMs, tamponade occurred in 2,595 patients (0.28%). The incidence rate steadily increased from 0.26% in 2008 to 0.35% in 2012 (p < 0.0001). Although the mean age and sex distribution did not change over the years, the rate of in-hospital mortality increased. After multivariate adjustment for patient and hospital characteristics, female sex (odds ratio [OR], 1.23; p = 0.011), dual-chamber pacemakers (OR, 1.68; p < 0.004), and chronic liver disease (OR, 3.18; p < 0.001) were independently associated with greater odds, while hypertension (OR, 0.71; p = 0.021) and atrial fibrillation (OR, 0.78; p = 0.002) were associated with lower odds of tamponade.
Conclusions:
The burden of cardiac tamponade associated with PPM implantation has steadily increased in the United States. Specific patient factors were identified that could predict the risk for developing tamponade among PPM recipients.
Perspective:
It is very concerning that over the short span of 4 years, the rate of cardiac tamponade increased by 35%. The reasons for this rise are not clear. Female sex, chronic liver disease, and dual-chamber device were risk factors, while hypertension and atrial fibrillation lowered the risk. These findings are consistent with a prior study on tamponade in patients with implantable cardioverter-defibrillators (Circ Cardiovasc Qual Outcomes 2013;6:582-90). Unfortunately, the NIS database does not contain information on some key factors one would like to know, such as the type of leads used or detailed information about anticoagulation. Furthermore, it is not reported whether procedural volumes or other physician factors may have played a role. The issue of rising incidence of tamponade is alarming, and should prompt confirmation and further elucidation.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Tamponade, Comorbidity, Defibrillators, Implantable, Heart Failure, Hospital Mortality, Hypertension, Liver Diseases, Pacemaker, Artificial, Secondary Prevention, Risk Factors, Sex Distribution
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