November 1, 1994Pacing and Clinical Electrophysiology218 citations
View Full PaperEarly Complications After Dual Chamber Versus Single Chamber Pacemaker Implantation
Key Result
Dual chamber (DDD) pacemaker implantation was associated with higher rates of early wound infection (2.1% vs 0.6%) and lead displacement (5.2% vs 1.0%) compared to single chamber (VVI) pacemakers.
Study Design
Type
Cohort (n=2,019)
Multicenter
No
Structured PICO
Does dual chamber pacemaker implantation increase early complications compared to single chamber pacemaker implantation in patients requiring permanent pacing?
P
Population
2,019 consecutive patients undergoing permanent pacemaker implantation, followed for 6 weeks to assess early complications.
E
Exposure
Dual chamber (DDD) permanent pacemaker implantation
C
Comparator
Single chamber (VVI) permanent pacemaker implantation
O
Outcome
Early complications (occurring in the 6-week period following implantation)safety
Dual chamber pacemaker implantation is associated with a higher incidence of early complications, specifically wound infection and lead displacement, compared to single chamber devices.
Abstract
This study was performed to compare the frequency of early complications after single chamber versus dual chamber permanent pacemaker implantation. Early complication was defined as one occurring in the 6-week period following implantation. We prospectively analyzed consecutive pacemaker implantation from January 1987 to June 1993 at our regional center. All complications were also analyzed for the relationship to operator experience, the venous access route, and the presence of temporary pacing wire at the time of implantation of the permanent pacing system. A total of 2019 new pacemaker units were implanted during this 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 patients and 15 (5.2%) DDD patients (11 3.8% atrial and 4 1.4% ventricular). There were 10 (0.6%) pneumothoraces, 9 (0.5%) hematomas requiring 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 pneumothorax when compared to the cephalic approach. The rate of wound infection was higher in patients who had a temporary pacing wire in place. The use of prophylactic antibiotics does not appear to affect the incidence of wound infection.(ABSTRACT TRUNCATED AT 250 WORDS)