Link M S, Estes N A, Griffin J J, Wang P J, Maloney J D, Kirchhoffer J B, Mitchell G F, Orav J, Goldman L, Lamas G A
New England Medical Center, Boston, MA 02111, USA.
J Interv Card Electrophysiol. 1998 Jun;2(2):175-9. doi: 10.1023/a:1009707700412.
Pacemakers are frequently implanted, yet accurate prospective data on implant complications are limited. Elderly patients may be at increased risk of implant complications and are increasingly being referred for pacemaker implantation. The purpose of the present analysis was to define the incidence and possible predictors of serious complications of dual chamber permanent pacemaker implantation in the elderly. Therefore, we sought to prospectively identify the incidence and predictors of pacemaker implant complications in a large multicenter trial involving patients receiving a dual chamber pacemaker. The Pacemaker Selection in the Elderly (PASE) study was a prospective trial designed to evaluate quality of life in dual chamber pacemaker recipients age 65 years or older randomized to DDDR versus VVIR programming. In addition to being age 65 years or older, patients enrolled in this study were in normal sinus rhythm, and had standard indications for permanent pacemaker implantation. All patients received dual chamber pacemakers and were randomized to DDDR versus VVIR pacing. Pacemaker implant complications were collected on standardized forms which were completed at pacemaker implantation and during follow-up appointments. In this study of 407 patients, there were 26 complications occurring in 25 patients (6.1%). The most frequent complication was lead dislodgment which occurred in 9 patients. This was followed by pneumothorax (8 patients) and cardiac perforations (4 patients). In 18 patients (4.4%) repeat surgical procedures (including chest tubes) were required. Complications were noted prior to discharge in only 18 patients. There were no significant predictors of overall complications. Pneumothorax was more frequent in patients > or = 75 years old, and was observed only in patients with subclavian venous access. In conclusion, complications from pacemaker implantation in the elderly are seen in 6.1% of patients and 4.4% of patients require a repeat surgical procedure. Other than advanced age and lower weight predicting for pneumothorax, there are no significant clinical predictors of complications.
起搏器植入手术较为常见，但关于植入并发症的准确前瞻性数据却很有限。老年患者植入并发症的风险可能更高，并且越来越多地被转诊接受起搏器植入手术。本分析的目的是确定老年患者双腔永久起搏器植入严重并发症的发生率及可能的预测因素。因此，我们试图在一项涉及接受双腔起搏器患者的大型多中心试验中前瞻性地确定起搏器植入并发症的发生率及预测因素。老年患者起搏器选择（PASE）研究是一项前瞻性试验，旨在评估年龄在65岁及以上、随机接受DDDR与VVIR程控的双腔起搏器植入患者的生活质量。除年龄在65岁及以上外，本研究纳入的患者为正常窦性心律，且有永久起搏器植入的标准指征。所有患者均接受双腔起搏器，并随机分为DDDR起搏组和VVIR起搏组。起搏器植入并发症通过标准化表格收集，这些表格在起搏器植入时及随访预约时填写。在这项对407例患者的研究中，25例患者出现了26例并发症（6.1%）。最常见的并发症是导线脱位，有9例患者发生。其次是气胸（8例患者）和心脏穿孔（4例患者）。18例患者（4.4%）需要再次进行手术操作（包括放置胸管）。仅18例患者在出院前发现有并发症。总体并发症没有显著的预测因素。气胸在75岁及以上患者中更常见，且仅在经锁骨下静脉穿刺的患者中观察到。总之，老年患者起搏器植入并发症的发生率为6.1%，4.4%的患者需要再次进行手术操作。除高龄和低体重是气胸的预测因素外，没有并发症的显著临床预测因素。
