Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience

Anita Shirwaiker, Jeremy William, Justin A. Mariani, Peter M. Kistler, Hitesh C. Patel, Aleksandr Voskoboinik

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2 Citations (Scopus)


Background: The long-term implications of pacemaker insertion in younger adults are poorly described in the literature. Methods: We performed a retrospective analysis of consecutive younger adult patients (18–50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986–2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed. Results: Eighty-one (81) patients (median age 41.0 yrs IQR=35–47.0 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1–14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients. Conclusions: Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.

Original languageEnglish
Pages (from-to)993-998
Number of pages6
JournalHeart Lung and Circulation
Issue number7
Publication statusPublished - 1 Jul 2022


  • Complications
  • Lead revision
  • Pacemaker
  • Young adults

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