Cardiac Device Implantation Complications Vary According to Institution

Implantable Defibrillator in surgeon's hands
Implantable Defibrillator in surgeon’s hands
This study adds to the understanding of the early complications associated with cardiovascular implantable electronic devices (CIEDs) and the institutional variability in the quality of CIED implantation.

In patients receiving cardiovascular implantable electronic devices (CIEDs), complications are common, and rates of complications vary across institutions, according to study results published in the Annals of Internal Medicine.1 The results also indicated that most CIED complications occur with permanent pacemakers (PPMs).

The study included patients aged >18 years who received a new CIED at 174 hospitals in Australia and New Zealand from 2010 to 2015 (n=81,304). The researchers measured risk-standardized complication rates (RSCRs) and frequencies of major device-related complications during hospitalization or within 90 days of discharge.

Of all participants, 65,711 received PPMs, and 15,593 received implantable cardioverter-defibrillators (ICDs). Mean age was 74.7 years with a standard deviation of 12.4 years.

A total of 8.2% of participants (n=6664) had a major complication.

Patients with ICDs had higher complication rates compared with patients with PPMs (10.04% vs 7.76%). However, 76.5% of all complications could be attributed to PPMs (5098 vs 1566 for ICDs).

In hospitals that implanted ≥25 CIEDs, the researchers found a median RSCR of 8.1%. However, RSRC rates varied from 5.3% to 14.3% and 22 hospitals had RSCRs that significantly differed from the national average.

The researchers noted similar variation in RSCRs when calculating PPM implantation and ICD placement separately. For PPM, the median RSCR was 7.6% in 96 hospitals, with a range of 5.4% to 12.9%. For ICD, the median RSCR was 9.7% for 68 hospitals, with a range of 6.2% to 16.9%. The variation persisted when assessing elective procedures only, with a median RSCR of 7.4% (range 4.7% to 13.0%) for 88 hospitals.

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A related editorial by Wong and Devereaux emphasized the importance of these findings. They concluded, “The current report identifies an important gap in the quality of CIED care among institutions, which will require integrated clinical and policy-focused interventions to optimize care.”2

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


1. Ranasinghe I, Labrosciano C, Horton D, et al. Institutional variation in quality of cardiovascular implantable electronic device implantation: a cohort study [published online July 30, 2019]. Ann Intern Med. doi:10.7326/M18-28102.

2. Wong JA, Devereaux PJ. Cardiac device implantation complications: a gap in the quality of care? [published online July 30, 2019]. Ann Intern Med. doi:10.7326/M19-1895