Cardiac Tamponade Incidence Has Increased in the United States

Cardiac tamponade, as a result of perforation during permanent pacemaker implantation, has increased in the United States, according to an analysis published in JACC: Clinical Electrophysiology.

Kasra Moazzami, MD of Rutgers New Jersey Medical School in Newark, and colleagues gathered data from 922 549 patients who received permanent pacemakers between 2008 and 2012. Single-chamber ventricular pacemakers were implanted in 17.6% (n=178 589) of patients, dual chamber pacemakers in 72.3% (n=733 638) of patients, and biventricular pacemakers in 10.1% (102 486) of patients.

Cardiac tamponade occurred in 2595 of these patients, with the in-hospital rate increasing by 35%. In 2008, the incidence rate was 0.26%; by 2012, it was 0.35% (P<.0001), and the in-hospital mortality rate also increased (P=.014). A total of 177 patients (6.8%) died, which was more than 6 times higher than patients who did not develop cardiac tamponade (1.1%; P<.001).

Mean age (71.41 ± 14.96 years) and distribution among genders did not change over time. Interestingly, studies that have investigated in-hospital adverse events related to implantable cardioverter debrillators have also revealed that women are more likely than men to develop cardiac tamponade.

In addition, Dr Moazzami and colleagues observed that patients who experienced cardiac tamponade had greater odds of postprocedural hospital stays longer than 3 days (odds ratio [OR]: 5.64; 95% confidence interval [CI]: 2.78-8.78; P<.001) and in-hospital death (OR: 6.41; 95% CI: 4.28-9.73; P<.001).

According to multivariable adjusted analysis, female sex (OR: 1.23; 95% CI: 1.04-1.54; P=.011), dual chamber pacemakers (OR: 1.68; 95% CI: 1.17-2.41; P<.004), and chronic liver disease (OR: 3.18; 95% CI: 1.92-5.64; P<.001) were independently associated with greater odds of cardiac tamponade while hypertension (OR: 0.71; 95% CI: 0.45-0.94; P=.021) and atrial fibrillation (OR: 0.78; 95% CI: 0.61-0.96; P=.002) were associated with lower odds. Patients who developed tamponade were also typically younger and had higher rates of congestive heart failure.

The researchers noted that women may experience higher rates of tamponade compared with men due to smaller body size and thinner myocardial wall.

“These findings provide insight into the increasing burden of tamponade among patients receiving PPM [permanent pacemaker] devices and help physicians to identify patients at highest risk for development of in-hospital tamponade following the procedure,” the authors concluded.

Reference

Moazzami K, Dolmatova E, Kothari N, Mazza V, Klapholz M, Waller AH. Trends in cardiac tamponade among receipts of permanent pacemakers in the United States: from 2008 to 2012. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.05.009.