Patient Demographics, Complications, and Hospital Utilization in 250 Consecutive Device Implants in a New Community Hospital Electrophysiology Program—Implications for ‘Niche’ Hospitals

Complications of Pacemaker Implantation

“…[8] CS lead placement at our Heart Rhythm Center without the use of contrast begins with CS access by engagement of the CS with a 5French octapolar deflectable electrophysiology (EP) catheter or hydrophilic coated 0.035" guidewire that the CS sheath is advanced over. Next, a 0.014" guidewire is advanced out distally and the entire CS is probed for LV branch vessels in 360 degree fashion; we then work proximally and if no braches are found (including very proximal posterolateral "bailout" vessels) then we repeat the process.…”

“…Pneumothorax may occur in as many as 3-4% [28,29] and as few as 0-1% [8,10,11,30,31,32] but generally ranges from 1-3% (5,9,33,34,35,36,37] of patients undergoing pacemaker implantation. Routine chest radiographs are often performed immediately after pacemaker implantation though clinical signs of pneumothorax include hypoxia, shortness of breath, pleuritic pain, and hypotension.…”

“…[5,8,10,31,32,35,36,37] In addition, asymptomatic subclinical perforation may occur in 15% of patients after device implantation. [43] Symptoms of perforation include pleuritic chest pain from pericarditis, diaphragmatic or intercostal muscle stimulation and, in the presence of pericardial effusion, patients may develop shortness of breath and hypotension as tamponade develops.…”

“…[50] Though we counsel our patients on a LV lead placement success rate at 88-92%, our center demonstrated a 97% success rate (64 of 66 patients) with LV lead placement within the range from 2:30 to 5:30 o'clock in the left anterior oblique (LAO) view. [8] Complications of biventricular pacing, specifically LV lead placement, include cardiac perforation, coronary sinus dissection, electrical trauma (damage to the native conduction system), failure to place the lead, dislodgement of the lead, and diaphragmatic stimulation.…”

“…Major and minor complications are defined based upon prior reports of device-related complications. [5,6,7,8] Major complications have been defined as death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arterial-venous fistula. Minor complications have been defined as drug reaction, conduction block, hematoma or lead dislodgement requiring reoperation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection.…”