Retrospective analysis of indications and complications related to implantation of permanent pacemaker: 25 years of experience in 31 dogs

Abstract

Introduction: Pacemaker implantation is the only effective symptomatic treatment for life-threatening bradyarrhythmias. Major complications observed after implantation of cardiac pacemakers include lead dislocation, loss of pulse generator function, and inadequate stimulation. The aim of this retrospective single-centre study was to analyse the indications for pacemaker implantation and the incidence and types of complications associated with this procedure in dogs treated for symptomatic bradyarrhythmia. Material and Methods: The retrospective analysis included 31 dogs with symptomatic bradyarrhythmia, implanted with permanent cardiac pacemakers in 1992–2017. The list of analysed variables included patient age, breed, sex, indication for pacemaker implantation, comorbidities, and the incidence of procedure-related complications along with the type thereof. Results: The most common indication for pacemaker implantation was 3rd degree AVB, followed by SSS, advanced 2nd degree AVB, and PAS. Pacemaker implantation was associated with a 35% overall complication rate and 6.45% periprocedural mortality. There were no significant differences in terms of procedure-related complications with regard to age, sex, breed, indications for pacemaker implantation, or comorbidities. Conclusions: Cardiac pacing is the only effective treatment of symptomatic bradycardia, but as an invasive procedure, may pose a risk of various complications, including death.

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

“…. 331–364 Most were case series or single case reports (LOE 5), and 1240 dogs were described, of which 60 had suspected or confirmed thrombosis (5%). Two studies were experimental (LOE 3) but of poor quality 336,361 .…”

“…The remaining supportive studies included 17 dogs with thrombosis following transvenous pacemaker implantation, typically in the cranial vena cava, some of which were fatal. Some studies reported comorbidities, including trauma, PLN and infection, that could have contributed to the risk of thrombosis 244,331,338,344,345,357,358,360,362,363 . Four publications (LOE 5) were considered neutral to the PECO question either due to lack of follow‐up, multiple possible causes for thrombosis, or reasons other than the presence of a pacemaker that were deemed likely to result in thrombosis (e.g., stenosis) 334,337,339,346 …”

“…Overall, 13 studies (1 LOE 3, 12 LOE 5) support the PECO question and suggest an association between transvenous pacemakers and thrombosis in dogs. 244,331,335,338,341,344,345,355,357,358,[360][361][362] The one LOE 3 report that supported the PECO question was a retrospective case series of 101 dogs that had polyurethane insulated transvenous pacemaker leads implanted. 361 These pacemakers were in place for between 10 days and 13 years before euthanasia and postmortem examination.…”

“…Some studies reported comorbidities, including trauma, PLN and infection, that could have contributed to the risk of thrombosis. 244,331,338,344,345,357,358,360,362,363 Four publications (LOE 5) were considered neutral to the PECO question either due to lack of follow-up, multiple possible causes for thrombosis, or reasons other than the presence of a pacemaker that were deemed likely to result in thrombosis (e.g., stenosis). 334,337,339,346 Eighteen studies (1 LOE 3 good, 17 LOE 5 good-fair) were judged to be neutral to the PECO question based on long-term follow-up of dogs after pacemaker implantation without reports of thrombotic complications.…”

Successful Clindamycin Therapy of an Infected Subcutaneous Permanent Pacing Lead in a Dog after a Failed Course with Potentiated Amoxicillin and Enrofloxacin

“…Permanent pacemaker implantation is known to have several possible minor and major complications [ 9 , 10 , 11 , 12 ]. One of the most common major complications is bacterial infection of the device [ 1 , 2 , 4 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Both the intracardiac and the subcutaneous parts of the system can be infected.…”