title: Complications of pacemaker therapy in adults with congenital heart disease: a multicenter study.
abstract: BACKGROUND
  This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD).
  
  
  RESULTS
  Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The indication for pacing was acquired sinus node or AV node conduction disease (63%), sinus node or AV node conduction disease after cardiac surgery (28%), and drug/arrhythmia-related indications (9%). Patients with complex CHD received a pacemaker at younger age (23 versus 31 years, p<0.0001) and more often received an epicardial pacing system (51% versus 23%, p<0.0001) compared to those with simple or moderate CHD. Twenty-nine patients (10.6%) had a periprocedural complication during the primary pacemaker implantation (general population: 5.2%). The most common acute complications were lead dysfunction (4.0%), bleeding (2.6%), pocket infection (1.5%) and pneumothorax (1.5%). During a median follow-up of 12 years, pacemaker-related complications requiring intervention occurred in 95 patients (34.6%). The most common late pacemaker-related complications included lead failure (24.8%), pacemaker dysfunction/early battery depletion (5.1%), pacemaker migration (4.7%) and erosion (4.7%). Pacemaker implantation at younger age (<18 years) was an independent predictor of late pacemaker-related complication (adjusted hazard ratio 1.68, 95% confidence interval 1.07 to 2.63, p=0.023).
  
  
  CONCLUSIONS
  The risk of periprocedural complications seems higher in the CHD population compared to the general population and more than one-third of CHD patients encountered a pacemaker-related complication during long-term follow-up. This risk increases for those who receive a pacemaker at younger age.
authors: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Petra
authors: P
authors: Opić
authors: Matthijs
authors: M
authors: van Kranenburg
authors: Sing-Chien
authors: SC
authors: Yap
authors: Arie P
authors: AP
authors: van Dijk
authors: Werner
authors: W
authors: Budts
authors: Hubert W
authors: HW
authors: Vliegen
authors: Lieselot
authors: L
authors: van Erven
authors: Anil
authors: A
authors: Can
authors: Gulhan
authors: G
authors: Sahin
authors: Dominic A M J
authors: DA
authors: Theuns
authors: Maarten
authors: M
authors: Witsenburg
authors: Jolien W
authors: JW
authors: Roos-Hesselink
mesh_terms: D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000639:trends; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complication; Congenital heart disease; Lead failure; Pacemaker; Tetralogy of Fallot; Transposition of the great arteries