Are Elderly Patients at Increased Risk of Complications Following Pacemaker Implantation? A Meta-Analysis of Randomized Trials

• Published in: Pacing and clinical electrophysiology Vol. 35; no. 2; pp. 131 - 134
• Main Authors: ARMAGANIJAN, LUCIANA V., TOFF, WILLIAM D., NIELSEN, JENS C., ANDERSEN, HENNING R., CONNOLLY, STUART J., ELLENBOGEN, KENNETH A., HEALEY, JEFF S.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-02-2012; Wiley
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Pacing, Artificial - mortality; complications; elderly; Female; Heart Failure - mortality; Heart Failure - prevention & control; Humans; Male; Medical sciences; Middle Aged; permanent pacemaker; Postoperative Complications - mortality; Prevalence; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic - statistics & numerical data; Risk Assessment; Risk Factors; Survival Analysis; Survival Rate; Treatment Failure; Human; Instrumental stimulation; Randomization; complications; Pacemaker; Risk factor; Instrumentation therapy; Complication; Elderly; permanent pacemaker; Metaanalysis
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2011.03240.x

Background:
 Patients over the age of 75 represent more than half the recipients of permanent pacemakers. It is not known if they have a different risk of complications than younger patients.
Methods:
 Patient‐level data were pooled from the CTOPP, UKPACE, and Danish pacing trials. These three randomized trials of pacing mode systematically captured early and late complications following pacemaker insertion. Early postimplant complications included lead dislodgement or loss of capture, cardiac perforation, pneumothorax, hematoma, infection, and death. Lead fracture was considered a late complication.
Results:
 A total of 4,814 patients were included in this analysis, with an average follow‐up of 5.1 years. The average age was 76 years and 43% were female. Any early complication occurred in 5.1% of patients ≥75 years of age compared to 3.4% of patients aged <75 years (P = 0.006). This was driven by an increased risk of pneumothorax (1.6% vs 0.8%, P = 0.07) and both atrial and ventricular lead dislodgement/loss of capture (2.0% vs 1.1%, P = 0.07). Early complications were higher in patients receiving atrial‐based pacemakers in both age groups (<75 years: 4.6% vs 2.4%; ≥75 years: 6.6% vs 3.7%); however, the relative risk was not influenced by age group. Older patients had a lower risk of lead fracture (3.6% vs 2.7%, P = 0.08).
Conclusion:
 Elderly patients (≥75 years of age) are at increased risk of early postimplant complications but are at lower risk for lead fracture. PACE 2012; 35:131–134)