Heart 1998;80:240-244 ( September )

Late complications following permanent pacemaker implantation or elective unit replacement

A A Harcombe,^a S A Newell,^a P F Ludman,^a T E Wistow,^a L D Sharples,^b P M Schofield,^a D L Stone,^a L M Shapiro,^a T Cole,^a M C Petch^a

^a Regional Cardiac Unit, Papworth Hospital NHS Trust, Cambridge CB3 8RE, UK, ^b MRC Biostatistics Unit, Research and Development Unit, Papworth Hospital NHS Trust

Correspondence to: Dr Petch.

Accepted for publication 6 April 1998

ObjectiveTo determine the rate of late complications following first implantation or elective unit replacement of a permanent pacemaker system.
DesignAnalysis of pacemaker data and complications prospectively acquired on a computerised database. Complications were studied over an 11 year period from January 1984 to December 1994.
SettingTertiary referral cardiothoracic centre.
PatientsRecords of 2621 patients were analysed retrospectively.
Main outcome measuresComplications requiring repeat procedures occurring more than six weeks after pacemaker implantation or elective unit replacement.
ResultsThe overall rate of late complications was significantly lower after first implantation of a permanent pacemaker (34 cases, complication rate 1.4%, 95% confidence interval 0.9% to 1.9%) than after elective unit replacement (16 cases, complication rate 6.5% (3.3% to 9.7%). There were 20 cases of erosion, 18 infections, five electrode problems, and seven miscellaneous problems. Complications were more common with inexperienced operators (18.9% (6.0% to 31.8%)) than with experienced operators (0.9% (0.3% to 1.5%)).
ConclusionsThe incidence of late complications following pacemaker implantation is low and compares favourably with early complication rates. The majority are caused by erosion and infection. Patients who have undergone elective unit replacement are at particular risk.

Keywords: permanent pacemaker;  elective unit replacement;  late complications;  arrhythmias

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© 1998 by Heart
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