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Incidence and predictors of cardiac perforation after permanent pacemaker placement.

Abstract：

BACKGROUND:Pericardial effusion, a sign of cardiac perforation, may complicate permanent pacemaker placement. Risk factors for development of post-permanent pacemaker effusion have not been evaluated. OBJECTIVES:The purpose of this study was to determine the predictors of symptomatic pericardial effusion after permanent pacemaker placement. METHODS:The Mayo Clinic pacemaker and echocardiogram databases were cross-referenced. From 1995 to 2003, 4,280 permanent pacemakers were implanted. Fifty (1.2%) patients developed significant effusion and symptoms consistent with perforation. They were randomly matched with 100 patients without effusion after permanent pacemaker placement. RESULTS:The strongest predictors of postimplant effusion by univariate analysis were the concomitant use of a temporary transvenous pacemaker (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.6-6.2, P = .001) or steroid use within 7 days prior to implant (HR 4.1, 95% CI 1.1-10, P = .003). Weaker predictors were use of helical screw ventricular leads, body mass index (BMI) <20, older age, and longer fluoroscopy times. Variables associated with lower risk of perforation were right ventricular systolic pressure >35 mmHg (HR 0.70, 95% CI 0.44-0.97, P = .01) or BMI >30 (HR 0.62, 95% CI 0.41-0.93, P = .01). Multivariate predictors were use of temporary pacemaker (HR 2.7, 95% CI 1.4-3.9, P = .01), helical screw leads (HR 2.5; 95% CI 1.4-3.8, P = .04), and steroids (HR 3.2, 95% CI 1.1-5.4, P = .04). Right ventricular systolic pressure >35 mmHg was the only protective factor (HR 0.70, 95% CI 0.50-0.92, P = .02). CONCLUSION:The incidence of postimplant effusions is low. In order to minimize periprocedural permanent pacemaker effusions, temporary pacemaker placement should be avoided unless essential, and particular care should be taken when placing a permanent pacemaker in patients who are taking steroids.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Mahapatra S,Bybee KA,Bunch TJ,Espinosa RE,Sinak LJ,McGoon MD,Hayes DL

doi

10.1016/j.hrthm.2005.06.011

keywords:

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

907-11

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(05)01761-3

journal_volume

pub_type

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Incidence and predictors of cardiac perforation after permanent pacemaker placement.