Nine-year single-center audit of cardiac implantable electronic device (CIED) procedures and operator-specific outcomes

Background The global implantation of cardiac implantable electronic devices (CIEDs) continues to rise, accompanied by growing emphasis on procedural safety and quality benchmarking. Accurate assessment of complication rates is essential to guide best practices, optimize patient outcomes, and drive institutional quality assurance initiatives. Purpose We sought to determine post CIED implantation complication rates over a nine-year study period and provide operator specific complication at a large academic center. Methods A comprehensive audit was conducted of all CIED procedures performed between April 2016 and June 2025 at a major Canadian academic institution. Data from 14 operators were extracted from electronic health records. Device type and complications including lead dislodgement, lead perforation, infection, pericardial effusion, pneumothorax, hemothorax, hematoma, and venous thromboembolism were retrieved. Results Over the nine-year study period, a total of 13,038 CIED procedures were performed, including 8,066 PPMs (62%), 2,204 ICDs (17%), 2,251 CRTs (17%), and 43 subcutaneous pacemakers. 16,011 leads were implanted: 4,157 RA, 10,271 RV, and 1,583 LV. The overall complication rate was 3.0%, of which 1.64% included lead dislodgement (n=77, 0.59%) or perforation (n=34, 0.26%), infection (n=65, 0.50%), pericardial effusion (n=17, 0.13%) and pneumothorax or hemothorax (n=21, 0.17%). Significant inter-operator variability was observed in perforation and infection rates (p = 0.008 and p < 0.001, respectively), with lower-volume operators demonstrating higher complication rates. Conclusions This nine-year, single-center audit demonstrates low complication rates for CIED implantation. The complication rates were higher among lower-volume operators, highlighting the impact of operator experience. These findings underscore the value of standardized implantation techniques, experienced operators, and robust peri-procedural care pathways. Continuous auditing of CIED outcomes remains a critical metric for institutional quality assurance and performance optimization.