Pericarditis following permanent pacemaker insertion.
BACKGROUND
The appearance of pericarditis following insertion of a permanent pacemaker is not widely acknowledged in the literature.


OBJECTIVE
To describe our experience with pericarditis following 395 permanent pacemaker implantations over 2 years.


METHODS
We retrospectively reviewed the medical records of 395 consecutive patients in whom new pacing systems or pacemaker leads had been implanted over a 2 year period. We searched the records for pericarditis that developed within 1 month after pacemaker implantation according to the ICD-9 code. The incidence, clinical picture, response to treatment, and relationship to lead design and location were studied.


RESULTS
Eight cases (2%) of pericarditis following implantation were detected. Clinical manifestations in all patients were similar to those of post-pericardiotomy syndrome and included chest pain (n = 7), friction rub (n = 1), fever (n = 2), fatigue (n = 2), pleural effusion (n = 2), new atrial fibrillation (n = 2), elevated erythrocyte sedimentation rate (n = 4), and echcardiographic evidence of pericardial effusion (n = 8). All affected patients had undergone active fixation (screw-in) lead implantation in the atrial position. The incidence of pericarditis with screw-in atrial leads was 3% compared to 0% in other cases (P < 0.05).


CONCLUSIONS
Pericarditis is not uncommon following pacemaker implantation with active fixation atrial leads. Special attention should be paid to identifying pericardial complications following pacemaker implantation, especially when anticoagulant therapy is resumed or initiated. The use of passive fixation leads is likely to reduce the incidence of pericarditis but this issue should be further investigated.
Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel.
Yair
Y
Levy
Ora
O
Shovman
Chava
C
Granit
David
D
Luria
Osnat
O
Gurevitz
David
D
Bar-Lev
Michael
M
Eldar
Yehuda
Y
Shoenfeld
Michael
M
Glikson
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010493:Pericarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal