An audit of permanent pacemaker implantations at the Charlotte Maxeke Johannesburg academic hospital from 2009 - 2018

Abstract

Background: Transvenous permanent pacemakers are electronic impulse generators indicated for implantation in patients with symptomatic bradycardia, commonly due to atrioventricular (AV) heart block or sick sinus syndrome. Biventricular cardiac resynchronisation therapy (CRT) pacemakers are indicated for implantation in patients with refractory, symptomatic heart failure with a broad QRS complex of more than 130 milliseconds. A large body of epidemiological data on permanent pacemaker implantation indications and complication rates originates from the developed world with minimal data from developing regions, especially sub-Saharan Africa. This study aims to describe and analyse the patient demographics, clinical indications, peri-operative and long-term complications as well as to find independent predictors of complications in patients undergoing permanent pacemaker implantation (PPI) at a high volume, teaching hospital in Johannesburg, South Africa. Methods: We retrospectively reviewed inpatient and outpatient medical records for all patients who underwent PPI at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between January 2009 and November 2018. Patients’ demographic data, medical co-morbidities, clinical indications, peri-implant laboratory biochemical markers, details of pacemaker mode and peri or post-procedure related complications were noted. Patients 18 years of age and above undergoing their first impulse generator implantation were eligible for analysis. Results: One thousand and sixty patients underwent permanent pacemaker implantation during the ten years. Only 578 (55%) patients met the study inclusion criteria. The median age at first permanent pacemaker implantation was 71.8 years [IQR: 61.5 – 78.8], and the study cohort consisted of 327 (56.6%) females. A total of 43 (7.45%) patients who experienced PPI related complications were identified. Lead dislodgement was the most common complication occurring in 16 (2.77%) patients. Females were three times more likely to experience a complication [OR: 3.21 CI: 1.37 – 7.56]. Conclusion: This study demonstrates that, in our cohort, symptomatic bradycardia requiring pacing is mostly a disease of the elderly with AV block being the most common indication for PPI. Our study complication rates are similar to those reported in data published from the developed world. Large, multicenter, prospective studies are required from our region to define better clinically relevant risk factors associated with PPI complications.