TY - JOUR
T1 - Long-Term Implications of Pacemaker Insertion in Younger Adults
T2 - A Single Centre Experience
AU - Shirwaiker, Anita
AU - William, Jeremy
AU - Mariani, Justin A.
AU - Kistler, Peter M.
AU - Patel, Hitesh C.
AU - Voskoboinik, Aleksandr
N1 - Funding Information:
A/Prof Voskoboinik is supported by an NHMRC Investigator Grant ( APP1194656 ).
Publisher Copyright:
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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.
AB - 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.
KW - Complications
KW - Lead revision
KW - Pacemaker
KW - Young adults
UR - http://www.scopus.com/inward/record.url?scp=85125477577&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2022.01.009
DO - 10.1016/j.hlc.2022.01.009
M3 - Article
C2 - 35219598
AN - SCOPUS:85125477577
SN - 1443-9506
VL - 31
SP - 993
EP - 998
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 7
ER -