Long-term implications of pacemaker insertion in younger adults: a single centre experience

Abstract

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 years) 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 81 patients (39.5±9.6 years, 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 7.6 (IQR=0.6–14.8) years follow-up, 9 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 of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further 9 patients (11%) experienced significant symptoms from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in 2 patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and 7 of these patients required subsequent biventricular upgrade. Furthermore, 4 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. FUNDunding Acknowledgement Type of funding sources: None.

Leadless pacing: Also an option for the young?

“…There are less mobility and sports restrictions and the lack of a pocket is a cosmetic advantage. Further, not only do young patients have a higher yearly risk of lead fractures, they also have more remaining years at risk of lead‐ and pocket‐related complications 6 . Hence, the lifetime risk reduction of those complications with LP therapy is expected to be greater in the young.…”

“…Further, not only do young patients have a higher yearly risk of lead fractures, they also have more remaining years at risk of lead-and pocketrelated complications. 6 Hence, the lifetime risk reduction of those complications with LP therapy is expected to be greater in the young. Besides, certain young patients may benefit from general LP advantages, such as patients with an increased infection risk.…”