Complications of dual chamber pacemaker implantation in the elderly

Pacemakers are frequently implanted, yet accurate prospective data on impla nt complications are Limited. Elderly patients mag be at increased risk of implant complications and are increasingly being referred for pacemaker imp lantation. The purpose of the present analysis was to define the incidence and possible predictors of serious complications of dual chamber permanent pacemaker implantation in the elderly. Therefore,we sought to prospectively identify the incidence and predictors of pacemaker implant complications i n a large multicenter trial involving patients receiving a dual chamber pac emaker. The Pacemaker Selection in the Elderly (PASE) study mas a prospecti ve trial designed to evaluate quality of life in dual chamber pacemaker rec ipients age 65 years or older randomized to DDDR versus VVIR programming. I n addition to being age 65 years or older, patients enrolled in this study were in normal sinus rhythm, and had standard indications for permanent pac emaker implantation. All patients received dual chamber pacemakers and mere randomized to DDDR versus VVIR pacing. Pacemaker implant complications wer e collected on standardized forms which were completed at pacemaker implant ation and during follow-up appointments. In this study of 407 patients, the re were 26 complications occurring in 25 patients (6.1%). The most frequent complication was lead dislodgment which occurred in 9 patients. This was f ollowed by pneumothorax (8 patients) and cardiac perforations (4 patients). In 18 patients (4.4%) repeat surgical procedures (including chest tubes) w ere required. Complications were noted prior to discharge in only 18 patien ts. There were no significant predictors of overall complications. Pneumoth orax was more frequent in patients greater than or equal to 75 years old, a nd was observed only in patients with subclavian venous access. In conclusi on, complications from pacemaker implantation in the elderly are seen in 6. 1% of patients and 4.4% of patients require a repeat surgical procedure. Ot her than advanced age and lower weight predicting for pneumothorax, there a re no significant clinical predictors of complications.