Key result
Dual-chamber pacemakers were the most frequently implanted devices (37.6%), primarily for complete heart block, with a low overall post-procedural mortality rate of 0.4%.
Why the study?
Trends in cardiac device implantation and interventions, along with patient outcomes, needed to be analyzed at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan.
Observational (n=5,166)
No
In a large Pakistani cohort, cardiac device implantation was primarily driven by complete heart block and associated with very low rates of complications and mortality.
Local trends in device implantation may guide resource planning; leaves open need for prospective outcome studies.
Objectives: To analyze trends in cardiac device implantation and interventions, along with patient outcomes, at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Methodology: This retrospective study was conducted from January 2017 to December 2020 at NICVD, Karachi. Patients presenting to outpatient or emergency departments with diagnoses of bradycardia (sinus node dysfunction or atrioventricular blocks), heart failure, survival of sudden cardiac death (SCD), or cardiomyopathy, and meeting the American College of Cardiology (ACC)/American Heart Association criteria for device-based therapies, were included. Data on demographic characteristics, comorbid conditions, device types, indications, and post-procedural outcomes, including complications and mortality, were collected and analyzed. Results: A total of 5,166 cases were analyzed over the four-year study period, with 2,991 (57.9%) males and a mean age of 58.2 ± 22.4 years. Hypertension was the most prevalent comorbidity, affecting 1,872 (36.2%) patients. Dual-chamber, rate-modulated pacemakers (DDDR) were the most frequently implanted devices, accounting for 1,943 (37.6%) cases, while single-chamber implantable cardiac defibrillators (ICDs) were predominantly used for secondary prevention in ischemic heart disease. Complete heart block was the most common indication, observed in 1,794 (34.7%) patients. Post-procedural complications were infrequent, with hematoma and wound infections being the most common. Mortality was reported in 23 (0.4%) patients. Conclusion: Dual-chamber, rate-modulated pacemakers (DDDR) emerged as the most frequently implanted pacemakers, while single-chamber ICDs were the preferred defibrillators for secondary prevention. Complete heart block was the leading indication for device implantation. Post-procedural complications, including hematoma and wound infection, were rare, and overall mortality associated with cardiac device implantation was remarkably low.
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Kubra et al. (2024) conducted an observational in Bradycardia, heart failure, sudden cardiac death survival, or cardiomyopathy (n=5,166). Cardiac device implantation was evaluated on Post-procedural mortality. Dual-chamber pacemakers were the most frequently implanted devices (37.6%), primarily for complete heart block, with a low overall post-procedural mortality rate of 0.4%.
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