Impact of Procedural Aspects on Early Complications After Permanent Cardiac Implantable Device Implantations

Background: Cardiac implantable devices (CIED) such as pacemakers, implantable cardioverter-defibrillators, or cardiac resynchronization devices are implanted in selected patients with bradyarrhythmia and advanced heart failure. The invasive character of these procedures poses a risk of early complications such as pneumothorax, bleeding, infections, or dislocations. Aims: There are no available data that analyzed the impact of the organization of procedures on the early complications risk after permanent pacing procedures. The aim of this study was to investigate if organizational aspects can impact early complications risk in CIED implantations. Methods: This retrospective study analyzed the medical records of 1673 patients who underwent CIED implantation at the Department of Cardiology of Cardinal Wyszynski Hospital in the years 2016-2020 (before the conduction system pacing era). Results: The regression analysis revealed the predictive value of the number of leads on complication risk overall (beta = 0.65, p < 0.001). Even though the significant differences in complications count were also observed for the consecutive days of the week (p = 0.002) and procedure order within the same day (p = 0.01), the regression analysis did not confirm their predictive value on complications' risk. However, the subgroup analysis regarding the device type revealed the significant predictive value of procedure order on complications in the single-chamber pacemaker subgroup (beta = 1.10, p = 0.01). Moreover, the subgroup analysis confirmed the predictive value of the number of leads on pneumothorax (beta = 0.89, p = 0.04) and dislocation (beta = 0.67, p = 0.01), age of the patient, and the assist with the less experienced operator on hemopericardium (beta = 0.11, p = 0.02, and beta = 2.34, p = 0.04, respectively). Conclusion: The study showed that the number of leads is the main factor of early complications after CIED implantations. In the simplest devices such as single-chamber pacemakers, the order of the procedure within the same day can also play a role in early complications risk.