[Complications of permanent cardiac pacing: a retrospective observational study of 462 cases from the University Hospital Center Hedi Chaker of Sfax, Tunisia].

Abstract

The benefits of permanent cardiac pacing have been widely demonstrated. However, the literature on complications remains inconsistent. We lack precise information about the frequency of complications and their predictive factors in our center. The purpose of this study was to determine the frequency of complications related to permanent cardiac pacing in our centre and to specify their predictive factors. We conducted a retrospective, observational, descriptive and analytical study. It involved patients who underwent an implantable electronic device (CIED) procedure, such as a pacemaker (PM) or implantable cardioverter-defibrillator (ICD) at the University Hospital Center of Sfax, Tunisia between January 2009 and December 2013. All clinical and paraclinical characteristics of the patients, their procedural data and any potential complications related to CIED implantation were collected (infectious complications, pocket hematomas, lead-related complications, vascular access complications, and complication-related mortality). Appropriate statistical tests were used to analyze the incidence of complications and their associated factors through multivariate analysis and to perform a survival analysis. We collected data from 462 procedures, including 420 PMs and 42 ICDs. The population had an average age of 72 ± 15 years. Hypertension was present in 55.1% of cases, diabetes in 22.3%, and 63.38% had underlying heart disease. A total of 64 complications were noted, accounting for 11.5% of the procedures. Complications were significantly more frequent with ICDs than PMs (23.8% vs. 10.2%; p=0.04). The incidence of infectious complications was 1.96%. Associated risk factors included diabetes (adjusted OR: 4.35, 95% CI 1.08-17.48; p=0.038) and reduced left ventricular ejection fraction (adjusted OR: 9.2, 95% CI 1.83-46.12; p=0.007). The incidence of pocket hematomas was 1.53%, with its associated risk factor being an indication for therapeutic anticoagulation (adjusted OR: 29.05, 95% CI 3.42-246.57; p=0.002). Lead-related complications were the most common (73.4% of complications). Their independent predictive factor was the number of manipulations greater than one (adjusted OR: 3.66, 95% CI 0.98-13.61; p=0.05). Among this subgroup, lead displacement was the most frequent (40.05%), with the presence of hypertensive heart disease as an associated risk factor (adjusted OR: 3.99, 95% CI 1.2-13.1; p=0.019). Vascular access complications were rare, occurring in 0.21% of cases. Mortality related to complications of cardiac device implantation was high (13.2%), particularly in the case of infectious complications (p=0.04). Overall survival at 5 years was 84.5%. The incidence of IEDC-related complications in the short and long term at our center was high, with a significant associated mortality, although comparable to the literature data. By identifying associated risk factors such as diabetes, heart failure, therapeutic anticoagulation, and repeat surgeries, we can adopt an informed therapeutic approach to reduce complications.