Incidence and predictors of cardiac perforation after permanent pacemaker placement.
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.


OBJECTIVE
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).


CONCLUSIONS
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.
Mahapatra
Srijoy
S
Division of Cardiology, Mayo Clinic, Rochester, Minnesota 55902, USA.
Bybee
Kevin A
KA
Bunch
T Jared
TJ
Espinosa
Raul E
RE
Sinak
Lawrence J
LJ
McGoon
Michael D
MD
Hayes
David L
DL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012107:Research Design; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D017211:Treatment Failure; D017725:Ventricular Pressure