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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prognostic factors in patients with an implanted pacemaker after 80 years of age in a 4-year follow-up.Gerontology. 2018; 64: 107-117
- Rehospitalizations for complications and mortality following pacemaker implantation: A retrospective cohort study in an older population.Clin Cardiol. 2018; 41: 1480-1486
- Investigation and treatment of high blood pressure in young people: too much medicine or appropriate risk reduction?.Hypertension. 2020; 75: 16-22
- Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant.Cardiol J. 2019; 26: 717-726
- Seventeen-year trend (2001-2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: an analysis by age groups.Eur J Intern Med. 2021; 84: 38-45
- Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population.Open Heart. 2014; 1e000177
- Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data.Circulation. 2006; 114: 11-17
- Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry.Neth Heart J. 2017; 25: 47-55
- Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark.Eur Heart J. 2014; 35: 1186-1194
- Younger age at time of pacemaker implantation is associated with worse survival.Ciculation. 2018; 122
- Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry.Circulation. 2010; 122: 1553-1561
- Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study.Heart Rhythm. 2012; 9: 728-735
- Long-term survival after permanent pacemaker implantation in young adults: 30 year experience.Pacing Clin Electrophysiol. 1999; 22: 407-412
- Complications arising after implantation of DDD pacemakers: the MOST experience.Am J Cardiol. 2003; 92: 740-741
- Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity.Heart. 2005; 91: 500-506
- Effect of long-term right ventricular pacing in young adults with structurally normal heart.Circulation. 2010; 121: 1698-1705
- Pacemaker complications in a district general hospital.Br J Cardiol. 2012; 19: 90-94
- Effects of increasing age onto procedural parameters in pacemaker implantation: results of an obligatory external quality control program.Europace. 2009; 11: 75-79
- Pacemaker implantation complication rates in elderly and young patients.Clin Interv Aging. 2013; 8: 1051-1054
- Are elderly patients at increased risk of complications following pacemaker implantation? A meta-analysis of randomized trials.Pacing Clin Electrophysiol. 2012; 35: 131-134
- Pacemaker leads: performance and progress.Am J Cardiol. 1999; 83: 187D-191D
- The electrode-tissue interface: the revolutionary role of steroid-elution.Pacing Clin Electrophysiol. 2014; 37: 1232-1249
- Effect of steroid elution on electrical performance and tissue responses in quadripolar left ventricular cardiac vein leads.Pacing Clin Electrophysiol. 2015; 38: 966-972
- Clinical significance of nonsustained ventricular tachycardia on stored electrograms in permanent pacemaker patients.Pacing Clin Electrophysiol. 2016; 39: 1335-1339
- Asymptomatic nonsustained ventricular tachycardia detected on pacemaker interrogation not associated with adverse outcomes and treatment remains unproven.Circulation. 2018; 134
- Ventricular function and long-term pacing in children with congenital complete atrioventricular block.J Cardiovasc Electrophysiol. 2007; 18: 373-377
- Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease.Cardiovasc Ultrasound. 2007; 5: 13
- Evolution of left ventricular function in paediatric patients with permanent right ventricular pacing for isolated congenital heart block: a medium term follow-up.Europace. 2007; 9: 228-232
- Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing.Circulation. 2004; 110: 3766-3772
- Impact of right ventricular pacing on three-dimensional global left ventricular dyssynchrony in children and young adults with congenital and acquired heart block associated with congenital heart disease.Am J Cardiol. 2009; 104: 700-706
- Long-term impact of right ventricular pacing on left ventricular systolic function in pacemaker recipients with preserved ejection fraction: results from a large single-center registry.J Am Heart Assoc. 2016; 5
- Biventricular pacing in patients with bradycardia and normal ejection fraction.N Engl J Med. 2009; 361: 2123-2134
- Incidence and predictors of right ventricular pacing-induced cardiomyopathy.Heart Rhythm. 2014; 11: 1619-1625
- Effects of right ventricular pacing on left ventricular ejection fraction in a pacemaker clinic.Acta Cardiol. 2012; 67: 577-582
- Percent right ventricular pacing predicts outcomes in the DAVID trial.Heart Rhythm. 2005; 2: 830-834
- The effect of right ventricular apical and nonapical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials.Pacing Clin Electrophysiol. 2015; 38: 1121-1136
- Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads.J Am Coll Cardiol. 2005; 45: 1672-1675
Article info
Publication history
Published online: February 23, 2022
Accepted:
January 9,
2022
Received in revised form:
January 7,
2022
Received:
November 9,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The Necessary Perils of Pacemaker Implantation in Young Individuals—Can We Do Better?Heart, Lung and CirculationVol. 31Issue 7
- PreviewIn the last two decades, there has been an increase in the implantation of permanent pacemakers (PPMs) [1–3]. Unlike similarly developed countries, Australia has not yet reached a plateau in demand for pacemaker implants [3]. Although the increase is driven by the ageing population, a rise in implantation of PPMs has been noted across all age groups. Acute complications from pacemaker implantation are well-recognised but the long-term implications of pacemaker implantation remain less well characterised, especially in the younger population.
- Full-Text
- Preview
