100 Procedural safety and long-term follow-up of pacemaker generator change in nonagenarians

IntroductionThe rate of pacemaker implantation over the last two decades has risen and will continue to rise as the population becomes more elderly. As such, the number of pacemaker generator changes performed in nonagenarians will also increase. There is little data regarding the risks associated with routine generator changes in this patient cohort. This is important as this cohort of patients are generally more frail and have more co-morbidities, potentially increasing the risks associated with generator change. We retrospectively analysed data on pacemaker generator changes in nonagenarians from a single high volume centre over 10 years.MethodsElectronic health record data were reviewed for all patients aged >90 undergoing pacemaker generator change between October 2010 and December 2021. 207 records were identified which met the inclusion criteria. 7 were excluded from the analysis as duplicate entries or occasions where the procedure was not begun due to patient factors such as advanced dementia or acute sickness. The primary outcome was any procedural-related complication occurring in the first year post generator change.ResultsThe mean age was 93 ± 2.34 years. 94 (47%) patients were male. 200 procedures were performed, of which 50 (25%) patients had a single-chamber pacemaker as their original device, 138 (69%) patients had a dual–chamber pacemaker, and 9 (4.5%) patients had a CRT-P device. 1 (0.5%) patient had a CRT-D device in situ, 1 (0.5%) patient had a single-chamber ICD, and 1 (0.5%) patient had a dual-chamber ICD. Twenty-two patients (11%) had a lead capped to convert dual-chamber pacemakers to single-chamber pacemakers. The average procedural time was 40 ± 16 minutes.Complications occurred in 13 patients (6.5%), of which 12 (6%) were classified as “minor”. The most common complication was poor lead performance requiring adjustment of thresholds at follow-up. This was seen in 7 patients (3.5%). The next most common complication was wound haematoma requiring conservative management, seen in 4 patients (2.0%). 1 patient had a minor wound infection, requiring further antibiotic treatment (0.5%). The only major complication seen was threatened erosion of the device, requiring re-siting, which occurred in 1 patient (0.5%). Following generator replacement, mean time to death was 895 ± 718 days. 2 patients died within 30 days of generator change.ConclusionComplication rates during and post generator replacement in nonagenarians are low, with very l