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Service de Cardiologie de la Clinique de la Dhuys | 1 rue Pierre et Marie Curie 93170 Bagnolet | France | Tel: 00 33 1 48 97 50 04 Our Department History - Description of our Department - Rhythmology news at the Clinique de la Dhuys - Our statistics |
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Commentary of the statistics
In January 2001, we started computerizing our data on the patients who had had pacemakers implanted. It enables us to better assess, each month, the impact of the new techniques we are using. This tool has become essential to our clinical research protocols and to the assessment of our new equipment. The number of implants has been steadily increasing in the last 10 years. The number of patients with implants across the nation has followed the same trend because of the aging of the population and the new implant indications. In 2005, over 50000 patients were implanted pacemakers in France. Most pacemakers implanted are dual chamber. The proportion decreases as people get older. The number of replacements of the devices tends to decrease since the new models have a longer lifespan. The complication rate is very low. The implant of a pacemaker is a minor surgery. The risks in operating do not depend on the age of the patient, but mainly on the underlying cardiopathy and the overall state of health. A 65 year-old patient with a history of heart trouble is considered as presenting higher risks than an 85 year-old patient with a healthy heart. You have to discriminate between immediate complications which arise in the post-surgery period and the late complications which arise some time after the surgical act. The displacement of leads happens less and less with the widespread use of « active » leads which are twisted/ fastened/ wired into the cardiac muscle. The risk of displacement reaches its peak in the days that follow the implant. That is why patients stay in the hospital a few days after the surgery. In case of displacement, the patient needs to be taken back to the operating room to reposition the lead. Haematomas are all the less frequent tha the patient is taking anticoagulant treatments to liquefy the blood. The risk increases with age since vascular sensitivity becomes more important. To prevent those complications, we systematically use a local anaesthetic which contains a vasoconstrictor. Moreover, each patient comes back from the operating room with a compressive dressing. Unfortunately, a serious/significant haematoma can require more/extra surgery. A pneumothorax can occur when the practitioner attempts to puncture the subclavian vein to introduce the heart stimulation leads. The needle can create a breach/ a fissure/ an opening in the pleura and cause the air to penetrate around the lung. As a consequence, one of the lungs can cease functioning temporarily. This unusual complication is easily treated through the setting of a drain which enables the air around the lung to be sucked up. Within the complications, particular attention should be paid to pacemaker infections. There is still much debate over its definition in the scientific community. It can be encountered in many clinical forms, more or less spectacular, the immediate dangerousness of which varies from a situation to another. In all cases, it requires quick and vigorous medical care in a specialized department. The therapeutic sanction necessarily entails the extraction of the whole device whether through endovascular or standard surgery. Prevention remains one of the best treatments. That is why we have devised preparation protocols for the patient and implemented very strict asepsis rules. Download the installation protocol. The complication rate varies according to the general state of the patient and the underlying cardiac predisposing factors. It decreases with the experience of the surgeon. The handling of complications due to the implant mainly depends on the quality of the medical staff and the technical platform. |
* requiring extra/more surgery 
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