EARLY COMPLICATIONS AFTER DUAL-CHAMBER VERSUS SINGLE CHAMBER PACEMAKER IMPLANTATION

This study was performed to compare the frequency of early complicatio ns after single ch amber versus du al chamber permanent pacemaker impl antation. Early complication was defined as one occurring in the 6-wee k period folio wing implantation. We prospectively analyzed consecutiv e pacemaker implantation from January 1987 to June 1993 at our regiona l center. All complications were also analyzed for the relationship to operator experience, the venous access route, and the presence of tem porary pacing wire at the time of implantation of the permanent pacing system. A total of 2019 new pacemaker units were implanted during thi s period. 1733 patients (85.8%) received a VVI pacemaker and 286 (14.2 %) a DDD unit. Wound infection occurred in 11 (0.6%) VVI patients and 6 (2.1%) DDD patients. Lead displacement occurred in 18 (1%) VVI patie nts and 15 (5.2%) DDD patients (11 [3.8%] atrial and 4 [1.4%] ventricu lar). There were 10 (0.6%) pneumothoraces, 9 (0.5%) hematomas requirin g drainage, 1 (0.06%) chylocele, and 2 (0.1%) deaths in the VVI group. There were 2 (0.7%) pneumothoraces, 2 (0.7%) hematomas, and no deaths in the DDD group. There was no significant increase in complications for experienced infrequent implanters (<12 systems per year). In both groups the subclavian approach was associated with a risk of pneumotho rax when compared to the cephalic approach. The rate of wound infectio n was higher in patients who had a temporary pacing wire in place. The use of prophylactic antibiotics does not appear to affect the inciden ce of wound infection. The early complications in the DDD group were h igher than in the VVI group (8.7% vs 2.9%, P<0.05), being mainly due t o an increased incidence of wound infection and atrial lead displaceme nt.