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Heart, Lung and Circulation

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

Published:February 23, 2022DOI:https://doi.org/10.1016/j.hlc.2022.01.009

      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

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      Linked Article

      • The Necessary Perils of Pacemaker Implantation in Young Individuals—Can We Do Better?
        Heart, Lung and CirculationVol. 31Issue 7
        • Preview
          In 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.
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