Background:

The aim of the present analysis was to depict the perioperative, intrahospital risk and occurrence of complications in patients after pacemaker (PM) and defibrillator (ICD) implantations in a large cohort, comparing single versus dual chamber devices.

Methods:

All hospitals in Germany are obliged to capture patient specific data for quality assurance for cardiac device implantation. The database (QS-NRW) from the state of North Rhine-Westphalia was used to examine 169.547 patients implanted between 2010 and 2014 with a single lead or dual lead PM (n=137.208) or ICD (n=32.339). The complications were analyzed separately for each device group. Groups with specific risk were identified and independent risk factors are described by their odds ratio (OR).

Results:

In the PM-group patients with an implanted dual lead device had significantly more complications than single lead devices (3,27% vs. 2,85%, p<0,001). In the ICD-group there were no significant differences in complication occurrence between single lead and dual lead ICD (1,39% vs. 1,46%, p= 0,635). The risk for an adverse event was more than twice higher during PM implantation compared to ICD (3,17% vs. 1,42%).

Independent risk factors in PM and ICD group were female sex, higher age and presence of left bundle branch block (LBBB).

Further independent risk factors for intrahospital adverse events In the PM-group were: congenital heart disease (CHD), carotis-sinus-syndrome (CSS), sick-sinus-syndrome (SSS), ASA-classification >2 and dual lead PM.  

In the ICD-group independent risk factors for adverse events were LVEF<50%, VDD-ICD, no diabetes, renal insufficiency without renal replacement therapy, primary prevention, right bundle branch block (RBBB) and non-permanent AF. Patients with an intrahospital adverse event had also a high risk for intrahospital mortality in both groups (PM: 4,5% vs. 1,6%; ICD: 3,9% vs. 0,5%)

Conclusions:

In this large, multicenter cohort dual chamber PM implantation had significantly more intrahospital adverse events compared to single chamber PM implantation. After ICD implantation, the present data did not show significant differences in intrahospital adverse events between single and dual lead devices. Perioperative complications are independently associated with several patient characteristics and with a higher intrahospital mortality.