The Necessary Perils of Pacemaker Implantation in Young Individuals—Can We Do Better?

Abstract

In the last two decades, there has been an increase in the implantation of permanent pacemakers (PPMs) [ 1 Greenspon A.J. Patel J.D. Lau E. Ochoa J.A. Frisch D.R. Ho R.T. et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures. J Am Coll Cardiol. 2012; 60: 1540-1545 Crossref PubMed Scopus (306) Google Scholar , 2 Zecchin M. Torre M. Carrani E. Sampaolo L. Ciminello E. Ortis B. et al. Seventeen-year trend (2001–2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: an analysis by age groups. Eur J Intern Med. 2021; 84: 38-45 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 3 Westaway S. Nye E. Gallagher C. Tu S.J. Clarke N. Hanna-Rivero N. et al. Trends in the use, complications, and costs of permanent pacemakers in Australia: a nationwide study from 2008 to 2017. Pacing Clin Electrophysiol. 2021; 44: 266-273 Crossref PubMed Scopus (4) Google Scholar ]. Unlike similarly developed countries, Australia has not yet reached a plateau in demand for pacemaker implants [ [3] Westaway S. Nye E. Gallagher C. Tu S.J. Clarke N. Hanna-Rivero N. et al. Trends in the use, complications, and costs of permanent pacemakers in Australia: a nationwide study from 2008 to 2017. Pacing Clin Electrophysiol. 2021; 44: 266-273 Crossref PubMed Scopus (4) Google Scholar ]. Although the increase is driven by the ageing population, a rise in implantation of PPMs has been noted across all age groups. Acute complications from pacemaker implantation are well-recognised but the long-term implications of pacemaker implantation remain less well characterised, especially in the younger population. Although this age group only accounts for a small proportion of overall pacemaker insertion [ [2] Zecchin M. Torre M. Carrani E. Sampaolo L. Ciminello E. Ortis B. et al. Seventeen-year trend (2001–2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: an analysis by age groups. Eur J Intern Med. 2021; 84: 38-45 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , [4] Dębski M. Ulman M. Ząbek A. Boczar K. Haberka K. Kuniewicz M. et al. Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant. Cardiol J. 2019; 26: 717-726 Crossref PubMed Scopus (6) Google Scholar ], their expected longevity predisposes them to complications [ [3] Westaway S. Nye E. Gallagher C. Tu S.J. Clarke N. Hanna-Rivero N. et al. Trends in the use, complications, and costs of permanent pacemakers in Australia: a nationwide study from 2008 to 2017. Pacing Clin Electrophysiol. 2021; 44: 266-273 Crossref PubMed Scopus (4) Google Scholar , 5 Bradshaw P.J. Stobie P. Knuiman M.W. Briffa T.G. Hobbs M.S.T. Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population. Open Heart. 2014; 1e000177 Crossref PubMed Scopus (93) Google Scholar , 6 Healey J.S. Toff W.D. Lamas G.A. Andersen H.R. Thorpe K.E. Ellenbogen K.A. et al. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation. 2006; 114: 11-17 Crossref PubMed Scopus (186) Google Scholar , 7 de Vries L.M. Dijk W.A. Hooijschuur C.A.M. Leening M.J.G. Stricker B.H.C. van Hemel N.M. Utilisation of cardiac pacemakers over a 20-year period: results from a nationwide pacemaker registry. Neth Heart J. 2017; 25: 47-55 Crossref PubMed Scopus (10) Google Scholar , 8 Kirkfeldt R.E. Johansen J.B. Nohr E.A. Jørgensen O.D. Nielsen J.C. Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark. Eur Heart J. 2013; 35: 1186-1194 Crossref PubMed Scopus (472) Google Scholar ]. Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre ExperienceHeart, Lung and CirculationVol. 31Issue 7PreviewThe long-term implications of pacemaker insertion in younger adults are poorly described in the literature. Full-Text PDF