Cardiology Letters 2024, 33(3):157-167

Peri-implantation and early post-implantation complications of cardiac implantable electronic devices (CIEDs) requiring revision. Unicentric study

Petra Ďurčíková, Gabriela Kaliská, Peter Bačík, Simona Siváková, Ján Šípka, Martin Škamla, Jakub Marko, Oskár Hurta, Adrian Bystriansky

II. klinika kardiológie a angiológie, Slovenská zdravotnícka univerzita a Stredoslovenský ústav srdcových a cievnych chorôb, a. s., Banská Bystrica, Slovenská republika

Introduction: In connection with the growing spectrum of indications for the implantation of cardiac implantable electronic devices (CIEDs), the number of peri-implantation and post-implantation complications is also increasing. Many of the complications are solvable with a conservative procedure, but more and more complications require an invasive procedure depending on the complication. The aim of the work is to evaluate peri-implantation and early post-implantation complications of cardiac implantable electronic devices (CIEDs), detected at the latest during the first outpatient check-up at our workplace, and which required revision or other early invasive therapeutic procedure. File and methods: We retrospectively analyzed a file of 3,251 consecutively enrolled patients for the period from 1/1/2020 to 11/9/2023, which amounts to 1,349 days. The following procedures were performed on the patients in the group: primary implantation KS: 1512 (47%), ICD: 886 (27%). Venous access through the subclavian/axillaris vein was the non-dominant approach for primary implantations, with a total of 983 punctures out of 2398 procedures (41%). Reimplantation KS: 521 (16%), ICD: 332 (10%). We defined peri-implantation complications as complications arising in the patient directly during the procedure in the operating theatre. Early post-implantation complications were defined as complications that occurred in the patient after leaving the operating theatre until the first outpatient check-up no later than 21.3±39.5 days; median 2 days. For statistical processing, we used the functions of the Microsoft Excel program.

Results: Occurrence of complications was found in 128 patients (3.9%), there were 131 complications (4%). The average age of the patient at the time of the procedure was 70±11 years. The vast majority of the group was represented by men 79 (62%). Peri-implantation complications occured only once, seen directly during the procedure in the operating theatre, and dissection of the coronary sinus during CRT implantation to the number of 6 (0.18%) Post-implantation complications occured in 3.84% of the total number of patients. Early post-implantation complications were pneumothorax 11 (0.34%), tamponade 2 (0.06%), KS/ICD pocket hematoma 21 (0.65%), electrode dislocation 86 (2.65%) (penetration and perforation/ macro - and microdislocation/stimulation threshold increase), system revision for loose fixation screw in device 2 (0.06%) and CIED infection 3 (0.09%). Complications per surgeon in our cardiac centre amount to 4±1%.

Conclusion: In nalysis of our group, in the total number of 3251 patients, complications showed in 128 patients (3.9%), and there were 131 complications (4%). Early post-implantation complications, namely electrode dislocations and pocket hematomas, were the largest number of complications.

Keywords: peri-implantation complications; early post-implantation complications; cardiac implantable electronic devices; patient; revision

Published: March 1, 2024  Show citation