title: Risk factors influencing complications of cardiac implantable electronic device implantation: infection, pneumothorax and heart perforation: a nationwide population-based cohort study.
abstract: As the number of cardiac implantable electronic devices (CIEDs) is increasing annually, CIED-related complications are becoming increasingly important. The aim of the study was to assess the risks associated with CIEDs by a nationwide database. Patients were selected from the Taiwan National Health Insurance Database. Admissions for CIED implantation, replacement, and revision were evaluated and the evaluation period was 14 years. Endpoints included CIED-related infection, pneumothorax, and heart perforation. The study included 40,608 patients with a mean age of 71.8 ± 13.3 years. Regarding infection, the incidence rate was 2.45 per 1000 CIED-years. Male gender, younger age, device replacement, and previous infection were risks for infection while old age and high-volume centers (>200 per year) were protectors. The incidence of pneumothorax was 0.6%, with an increased risk in individuals who had chronic obstructive lung disease (COPD) and cardiac resynchronized therapy (CRT). The incidence of heart perforation was 0.09%, with an increased risk in individuals who had pre-operation temporal pacing and steroid use. High-volume center was found to decrease infection rate while male gender, young people, and individuals who underwent replacements were associated with an increased risk of infection. Additionally, pre-operation temporal pacing and steroid use should be avoided if possible. Furthermore, COPD patients or those who accept CRTs should be monitored closely.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (YSL, CMC); Chang Gung University College of Medicine, Taoyuan, Taiwan (SPH, PRC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou, Taiwan (CHY, HTW, PCC, CCW, CCC, MSW, THC); Department of Cardiology, Chang-Gung Memorial Hospital, Xiamen, China (THC); and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University (YSL).
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.forename: Sheng-Ping
authors.initials: SP
authors.lastname: Hung
authors.forename: Pei-Rung
authors.initials: PR
authors.lastname: Chen
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yang
authors.forename: Hung-Ta
authors.initials: HT
authors.lastname: Wo
authors.forename: Po-Cheng
authors.initials: PC
authors.lastname: Chang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.forename: Chung-Chuan
authors.initials: CC
authors.lastname: Chou
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Wen
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Chung
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult