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Are Elderly Patients at Increased Risk of Complications Following Pacemaker Implantation? A Meta‐Analysis of Randomized Trials
Author(s) -
ARMAGANIJAN LUCIANA V.,
TOFF WILLIAM D.,
NIELSEN JENS C.,
ANDERSEN HENNING R.,
CONNOLLY STUART J.,
ELLENBOGEN KENNETH A.,
HEALEY JEFF S.
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03240.x
Subject(s) - medicine , pneumothorax , complication , surgery , randomized controlled trial , perforation , relative risk , confidence interval , materials science , punching , metallurgy
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)