Comparison of lead dislodgment and pocket infection rates after pacemaker implantation in the operating room versus the catheterization laboratory

doi:10.1016/0002-8703(88)90075-0

American Heart Journal

Volume 115, Issue 5, May 1988, Pages 1048-1051

https://doi.org/10.1016/0002-8703(88)90075-0 Get rights and content

Abstract

To assess and compare the rates of lead dislodgment and pocket infection in patients having procedures performed in the operating room versus those performed in the cardiac catheterization laboratory, we reviewed the records of 85 adult patients who underwent 88 procedures, all performed by one surgical team and having complete follow-ups at our institution from October 8, 1979, through November 7, 1986. Forty-five patients underwent 46 procedures in the operating room, and 40 patients underwent 42 procedures in the cardiac catheterization laboratory. There was one instance of ventricular lead dislodgment noted among the 48 leads implanted in the operating room and one instance of ventricular lead dislodgment among the 58 leads implanted in the cardiac catheterization laboratory. No instances of atrial lead dislodgment were noted. No instances of pocket infection were noted among the 46 procedures performed in the operating room or in the 42 procedures performed in the cardiac catheterization laboratory. We conclude that pacemaker implantation can be performed with equivalent safety and effectiveness in the cardiac catheterization laboratory and in the operating room.

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Cited by (20)

The effect of a surgical safety checklist on complication rates associated with permanent transvenous pacemaker implantation in dogs
2019, Journal of Veterinary Cardiology
Citation Excerpt :
Higher complication rates have been reported in dogs with pre-existing structural heart disease [6], postoperative infections [13], previously used pulse generators [6], inexperienced operators [4], and procedures performed after normal business hours [11]. In comparison, large-scale retrospective studies in humans report major complication rates of 2.3–11.2% [14–17]. A growing body of evidence in human medicine suggests that surgical safety checklists (SSCs) are a useful tool to improve communication among surgical team members and reduce incidence of surgical complications.
To determine whether use of a surgical safety checklist (SSC) would reduce the rate of major complications after permanent transvenous pacemaker implantation in dogs.
The study included one hundred ninety-nine dogs undergoing pacemaker implantation for bradyarrhythmias at an academic teaching hospital.
A service-specific SSC was developed and implemented for cardiac catheterization procedures in 2015. Medical records were reviewed to extract relevant clinical and procedural data for cases with (SSC [+]) and without (SSC [−]) a checklist. Owners or referring veterinarians were contacted for outcome and survival data.
Major complications occurred in 25/199 (12.6%) dogs. Incidence of major complications was significantly lower in SSC [+] dogs compared with SSC [−] dogs (1/45 procedures vs 24/144 procedures; p = 0.019). Dogs with SSCs were more likely to receive antibiotics within 5 min of the first incision (p = 0.0082) and to receive antibiotics every 90 min throughout the procedure as prescribed (p = 0.001) compared with dogs without SSCs. Incidence of cardiac death was lower in SSC [+] dogs compared with SSC [−] dogs (p = 0.0012), but checklist use was not associated with increased survival time (all-cause or cardiac). On average, 91% of checklist components were completed for each SSC; minor changes in record-keeping protocols could increase compliance.
Use of an SSC was associated with a decrease in the major complication rate and an increase in compliance with antibiotic protocols during pacemaker implantation. Results of this study support the use of an SSC in veterinary cardiology procedures.
Pacemaker and implantable cardioverter-defibrillator emergencies
2010, Cardiac Intensive Care: Expert Consult
Pacemaker and Implantable Cardioverter-Defibrillator Emergencies
2010, Cardiac Intensive Care
Cardiac pacemakers: Current and Future Status
1999, Current Problems in Cardiology
Should surgeons still be implanting pacemakers?
1994, The Annals of Thoracic Surgery
Cardiac pacing has undergone major changes in the areas of manpower, technology, and cost over the past 10 years. Arguments have been made to eliminate cardiac surgical involvement in pacing on the basis of these three areas of change: implantations are increasingly performed by nonsurgeons, surgeons have not kept up with the technologic advances in pacing, and consolidation of bradypacing resources is necessary during a time when reimbursement has declined significantly. This study examined two eras of pacing therapy at an institution where pacemaker implantation has always been performed by cardiothoracic surgeons. The purpose of the study was to critically analyze (1) the current role (if any) of cardiothoracic surgeons in delivery of pacemaker therapy and (2) the current results of cardiothoracic surgical involvement in pacemaker implantation. In 1,562 procedures performed between 1986 and 1992, the infection rate was 0.51% and the overall complication rate (both short-term and long-term) was 5.2%. During era 1 (1/1/86 to 6/30/89), 80% of implants were single-chamber and follow-up was incomplete and dependent in many instances on the referring cardiologist/internist. For the implantations performed in the second era (7/1/89 to 12/31/92) as part of an established Pacemaker Service, complete clinical and transtelephonic follow-up services were provided by this coordinated medical-surgical approach. During era 2, 53.9% of implants were dual-chamber (79% during 1992). Total and infectious complication rates remained low in era 2 despite this change in technology. These data mitigate against the arguments made above to eliminate surgical involvement in bradypacing, and demonstrate that cardiothoracic surgical expertise can be integrated into and significantly contribute to a “Center of Excellence” approach to pacemaker therapy. These issues should be considered as government, third-party payors, and hospitals consider bradypacing therapy as a target for health care reform.
Pacemakers in children: An update
1989, American Heart Journal
This report reviews recent pacemaker technological advances as they apply to infants, children, and adolescents. Indications for pacemaker implantation in children have evolved since the 1984 Joint Task Force Guidelines. Recent data show that pacemaker implantation should be strongly considered in patients who have (1) asymptomatic congenital complete AV block with a mean heart rate less than 50 beats/min or other evidence of junctional instability; (2) congenital AV block with long QT interval; or (3) congenital long QT syndrome with bradyarrhythmias, or when conventional beta-blocker therapy is unsuccessful. Permanent pacemaker implantation is not necessarily an effective prophylactic measure against sudden death in patients following their operation who are receiving drug therapy for atrial tachyarrhythmias, and so is not absolutely indicated.
New developments in lead technology have made transvenous lead systems more feasible for pediatric use. Because epicardial leads are required for small infants and for cosmetic reasons in some older children, design improvements are needed to enhance epicardial lead performance. Rate-responsive pacing is an acceptable alternative to dualchamber pacing for augmenting exercise tolerance, and for children with sinus node dysfunction it is the preferred pacing mode. Pacemakers with automatic antitachycardia capabilities and with noninvasive electrophysiology features are valuable in children with atrial tachyarrhythmias. New data suggest that chronic atrial pacing also may be effective in controlling atrial tachyarrhythmias. New developments in pacemaker systems for the young parallel those for the older population, but differences between adult and pediatric patients demand ongoing increased participation by pediatric cardiologists.

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Clinical investigationComparison of lead dislodgment and pocket infection rates after pacemaker implantation in the operating room versus the catheterization laboratory

Abstract

Am J Cardiol

The proliferation of cardiac pacing: medical, technical and socioeconomic dilemmas

Circulation

Clinical investigation
Comparison of lead dislodgment and pocket infection rates after pacemaker implantation in the operating room versus the catheterization laboratory