Key result
Post-cardiac surgery CIED complications linked to ~27% higher risk of heart failure or CV mortality.
Why the study?
Patients undergoing cardiac surgery often require postoperative CIED implantation due to high age and comorbid burden. Whether the type of prior cardiac surgery influences CIED complication rates, procedure duration, and subsequent long-term clinical outcomes needed systematic evaluation.
Does the type of prior cardiac surgery influence the complication rates of subsequent cardiac implantable electronic device (CIED) implantation and long-term clinical outcomes (heart failure and/or cardiovascular mortality) in cardiac surgery patients?
Cohort (n=75,073)
Yes
Does the type of prior cardiac surgery influence the complication rates of subsequent cardiac implantable electronic device (CIED) implantation and long-term clinical outcomes (heart failure and/or cardiovascular mortality) in cardiac surgery patients?
In a large nationwide Swedish cohort, 10% of cardiac surgery patients required a postoperative CIED with a 5.5% complication rate, where prior arrhythmia surgery increased complication risk and procedural complications independently predicted long-term heart failure or cardiovascular death.
CIED complications after cardiac surgery were associated with higher HF/CV mortality; hypothesis-generating for prevention trials before practice change.
Background Cardiac surgery is performed in patients with a large comorbid burden and high age, which increases the need for postoperative cardiac implantable electronic device (CIED) implantation and subsequently, complications related to CIED implantation. Purpose We hypothesized that type of cardiac surgery may influence the complication rates of CIED implantation and may consequently affect long term clinical outcomes. Therefore, this study aimed to systematically evaluate complication rates and procedure duration associated with CIED implantation in patients with prior cardiac surgery. Methods The study included all patients who underwent cardiac surgery due to coronary artery and/or valvular disease in Sweden between January 2006 and December 2020. Adjusted logistic and Cox regression analyses were used to evaluate the risk of complications and subsequent long-term outcomes after complications. The study population was derived from The Swedish Cardiac Surgery Registry, part of the SWEDEHEART registry. Comorbidities were identified in Sweden's National Patient Register. CIED procedures and complications were identified via the Swedish ICD and Pacemaker Registry. Any CIED procedure were included. Complications include arrhythmia requiring medication, perforation/tamponade, pneumothorax, hemothorax, venous embolism/thrombosis, stroke, local bleeding, pericardial fluid, infection, electrical dysfunction, lead dislodgement, and death. Results A total of 75,073 patients were included in the cardiac surgery cohort, of these 7,510 (10,0%) required a CIED at any point after surgery. The overall risk of complications following device implantation among cardiac surgery patients was 5.5%, at any point during a mean follow-up of 6.7 years. The most common complication was lead dislodgement which occurred in 2.0% of patients, Figure 1. There was no difference between the risk of device complication for valvular surgery or combined coronary/valve surgery compared to coronary artery bypass grafting. However, arrhythmia surgery was associated with an increased risk of device-related complications (odds ratio [OR] 1.67 [95% confidence interval 1.02-2.67], p=0.036). Procedural duration demonstrated a nonlinear association with complication risk, with increased risk at both shorter and longer procedure times. Implant procedure complications were associated with the primary combined outcome of heart failure and/or cardiovascular mortality (adjusted hazard ratio 1.27 [95% CI 1.05-1.54], p=0.016), in patients who had a pacemaker implanted. Conclusion Implantation of a cardiac implantable electronic device is common after cardiac surgery during long-term follow-up. Arrhythmia surgery conferred an increased risk of device-related complications. Furthermore, complications related to device implantation were independently associated with a higher risk of subsequent long-term adverse outcomes in patients who underwent CIED implantation.
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Ragnvaldsson et al. (2026) conducted a cohort in Cardiac surgery patients requiring cardiac implantable electronic device (CIED) implantation (n=75,073). CIED implantation complications and arrhythmia surgery vs. Uncomplicated CIED implantation and coronary artery bypass grafting was evaluated on Combined outcome of heart failure and/or cardiovascular mortality (HR 1.27, 95% CI 1.05-1.54, p=0.016). CIED implantation after cardiac surgery had a 5.5% complication risk, which increased heart failure or cardiovascular mortality (adjusted HR 1.27; 95% CI 1.05-1.54; p=0.016).
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