Incidence and predictors of cardiac perforation after permanent pacemaker placement

Srijoy Mahapatra, Kevin A. Bybee, T. Jared Bunch, Raul Emilio Espinosa, Lawrence J. Sinak, Michael D. McGoon, David L. Hayes

Research output: Contribution to journalArticle

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Abstract

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. Objectives: 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 cr oss-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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)907-911
Number of pages5
JournalHeart Rhythm
Volume2
Issue number9
DOIs
StatePublished - Sep 2005

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Confidence Intervals
Incidence
Pericardial Effusion
Steroids
Body Mass Index
Ventricular Pressure
Databases
Blood Pressure

Keywords

  • Complication
  • Pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mahapatra, S., Bybee, K. A., Bunch, T. J., Espinosa, R. E., Sinak, L. J., McGoon, M. D., & Hayes, D. L. (2005). Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm, 2(9), 907-911. https://doi.org/10.1016/j.hrthm.2005.06.011

Incidence and predictors of cardiac perforation after permanent pacemaker placement. / Mahapatra, Srijoy; Bybee, Kevin A.; Bunch, T. Jared; Espinosa, Raul Emilio; Sinak, Lawrence J.; McGoon, Michael D.; Hayes, David L.

In: Heart Rhythm, Vol. 2, No. 9, 09.2005, p. 907-911.

Research output: Contribution to journalArticle

Mahapatra, S, Bybee, KA, Bunch, TJ, Espinosa, RE, Sinak, LJ, McGoon, MD & Hayes, DL 2005, 'Incidence and predictors of cardiac perforation after permanent pacemaker placement', Heart Rhythm, vol. 2, no. 9, pp. 907-911. https://doi.org/10.1016/j.hrthm.2005.06.011
Mahapatra, Srijoy ; Bybee, Kevin A. ; Bunch, T. Jared ; Espinosa, Raul Emilio ; Sinak, Lawrence J. ; McGoon, Michael D. ; Hayes, David L. / Incidence and predictors of cardiac perforation after permanent pacemaker placement. In: Heart Rhythm. 2005 ; Vol. 2, No. 9. pp. 907-911.
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title = "Incidence and predictors of cardiac perforation after permanent pacemaker placement",
abstract = "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. Objectives: 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 cr oss-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). Conclusion: 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.",
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AU - Mahapatra, Srijoy

AU - Bybee, Kevin A.

AU - Bunch, T. Jared

AU - Espinosa, Raul Emilio

AU - Sinak, Lawrence J.

AU - McGoon, Michael D.

AU - Hayes, David L.

PY - 2005/9

Y1 - 2005/9

N2 - 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. Objectives: 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 cr oss-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). Conclusion: 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.

AB - 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. Objectives: 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 cr oss-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). Conclusion: 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.

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