[Current intra- and early postoperative results of transvenous pacemaker implantation]

Between 1986 and 1989 295 pacemaker (PM)-implantations were performed (mean age: 69.9 +/- 14.5 years; 54.9% male, 45.1% female).AV-Block II+III (36.6%), sick-sinus-syndrome (26.4%), bradyarrhythmia (18.0%). Concomitant disease: hypertension (40.6%), diabetes mellitus (19.3%), coronary artery disease (11.5%), malignant tumors (10.8%), renal failure (7.5%). We implanted in 72.9% VVI-PM, in 23.7% DDD-PM and in 3.4% AAI-PM. The median fluoroscopy-time as a measure for time of surgery was 6.2 minutes (DDD: 6.7; VVI: 5.4; AAI: 9.9). In 6.5% there were intraoperative complications: arrhythmias (3.4%), skeletal muscular stimulation (M.pect.; 1.4%), lead dislodgment (0.7%), missed puncture (A.subcl.; 0.7%). The early postoperative (14 days) complications rate was 9.5% (lead dislodgment 3.7%, development of high threshold 1.7%, bleeding 1.4%, bacteriaemia 1.0%, skeletal muscular stimulation 0.7%). The complication rate of AAI-PM (70.0%) was significantly higher compared to DDD-PM (29.8%; p less than 0.01) and VVI-PM (12.1%; p = 0.00025). In 17 patients (5.8%) reoperation was necessary (lead dislodgment n = 11, development of high threshold n = 3, arrhythmias n = 2, postoperative bleeding n = 1). The highest dislodgment rate was seen in atrial leads with active fixation (5.0%). In 2.6% of active fixation leads there was a development of high thresholds (passive fixation leads 0.5%). The selection of the PM-system to be implanted has to be considered in respect to the increased complication rate of DDD- and AAI-PM, especially in elderly patients.