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Cardiac tamponade rates increasing among recipients of permanent pacemakers
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The rate of cardiac tamponade among patients with permanent pacemakers increased from 0.26% in 2008 to 0.35% in 2012, researchers reported in JACC: Clinical Electrophysiology.
Researchers used the Nationwide Inpatient Sample to identify trends in cardiac tamponade among patients who received a permanent pacemaker in the United States between 2008 and 2012.
Among the 922,549 permanent pacemaker implantations that occurred during this period, 2,595 patients (0.28%) developed in-hospital cardiac tamponade. Patients who developed tamponade (mean age, 71 years; 55% women) were more likely to be younger (P < .0001), have a longer hospital stay (P < .0001), and to have higher rates of congestive HF (P = .005) and chronic liver disease (P < .0001), but to have lower rates of diabetes and hypertension (P = .002 for both).
Although the incidence cardiac tamponade rate increased from 0.26% to 0.35% (P < .0001), the data showed that the mean age and sex distribution of patients experiencing tamponade did not change between 2008 and 2012. However, increases in rates of associated comorbidities were observed.
Of the patients who developed in-hospital tamponade, 177 (6.8%) died while in the hospital. This number is six times higher than the number of patients with permanent pacemakers who did not develop tamponade (1.1%; P < .0001). The rate of in-hospital mortality among those with cardiac tamponade rose between 2008 and 2012 (P = .014), according to the researchers.
After adjustment, cardiac tamponade was associated with greater odds of a postprocedural hospital stay of more than 3 days (adjusted OR = 5.64; 95% CI, 2.78-8.78) and in-hospital mortality (adjusted OR = 6.41; 95% CI, 4.28-9.73).
Female sex (OR = 1.23; 95% CI, 1.04-1.54), chronic liver disease (OR = 3.18; 95% CI, 1.92-5.64) and dual-chamber device implantation (OR = 1.68; 95% CI, 1.17-2.41) were independent predictors of cardiac tamponade, whereas hypertension (OR = 0.71; 95% CI, 0.45-0.94)and atrial fibrillation (OR = 0.78; 95% CI, 0.61-0.96) were associated with lower odds of tamponade, according to the researchers.
“These findings provide insight into the increasing burden of tamponade among patients receiving [permanent pacemaker] devices and helps physicians identify patients at highest risk for development of in-hospital tamponade following the procedure,” the researchers wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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M. Rizwan Afzal, MD
Moazzami and colleagues reported an interesting finding from the retrospective review of the NIS database that the incidence of the permanent pacemakers is increasing. There are some limitations of the study. The most important is the lack of temporal relationship of cardiac tamponade and the permanent pacemaker implantation. The database analyzed is from the payer’s database, which accounts for the diagnoses entertained during a particular hospital stay. A patient may have been admitted for CABG and developed cardiac tamponade and subsequently received permanent pacemaker implantation. In this retrospective review, this would be accounted for as a complication of the permanent pacemaker implantation.
If we are able to prove with temporal association that there is an increasing incidence of cardiac tamponade with permanent pacemaker implantation, there are a few possible reasons. From 2008 to 2012, there was an increasing number of patients receiving a permanent pacemaker after transcatheter aortic valve replacement. These patients undergo multiple percutaneous procedures as well as receive dual antiplatelet therapy. This population is vulnerable to cardiac tamponade. In addition, from 2008 to 2012, the use of active fixation leads has increased, which can potentially confer higher risk for cardiac perforation and thus tamponade.
Further prospective studies are needed to prove permanent pacemaker implantation is associated with increasing incidence of cardiac tamponade.
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