Association of body mass index with complications in cardiac implantation electronic devices: A retrospective single-center cohort study

Cardiac implantable electronic devices (CIEDs) are increasingly used for managing arrhythmias and advanced heart failure, but implantation procedures carry risks of bleeding, infection, and mechanical complications. Patient-related factors such as obesity and comorbidities, alongside perioperative anticoagulation, may influence outcomes, yet evidence from South Asian populations is limited. We conducted a single-center observational study of 1925 patients who underwent CIED procedures between January 2010 and October 2025 at a tertiary heart center in Pakistan. Patients were categorized by body mass index (BMI) (non-obese, overweight, obese). Anticoagulation and antiplatelet management followed standardized protocols. The primary endpoint was a composite of clinically significant hematoma, pneumothorax, pericardial effusion/tamponade, and device-related infection. Secondary endpoints included each complication separately. Logistic regression was used to identify predictors of adverse events. The mean age of the cohort was 62.3 ± 12.5 years, with 59.9% male. The composite primary endpoint occurred in 70 patients (3.6%), with significantly higher rates in obese individuals (10.4%) compared with overweight (4.3%) and non-obese patients (3.0%, P = .001). Clinically significant hematoma (0.6%) and pneumothorax (1.2%) were more frequent in obese patients ( P = .04). Device-related infection occurred in 2.0%, with a trend toward higher incidence in obese patients ( P = .06). On multivariate analysis, hypertension (OR 4.768, P < .001), male sex (OR 1.882, P = .04), and BMI (OR 1.069, P = .03) were independent predictors of complications. Obesity, hypertension, and male sex significantly increase complication risk following CIED implantation. Incorporating these risk factors into pre-procedural planning and perioperative management may improve procedural safety in high-risk patients.