Clinico-demographic Profile of Patients Receiving Permanent Pacemakers as Bradyarrhythmia Therapy: The Srinagar Registry

Abstract

Introduction Cardiac conduction disorders can interrupt the normal electrical conduction in the heart and cause a decrease or cessation of pulse generation and a fall in organ perfusion in the body. This can lead to significant morbidity and mortality. This study was conceived to illustrate the clinical profile, presentation, management, and complications of bradyarrhythmia therapy in this population. Methods This descriptive cross-sectional study included prospective and retrospective data over a period of 16 years. All patient’s demographic data and data of any complications and adverse outcomes were documented. Results A total of 3489 cases having permanent pacemakers (PPMs) implanted in them were included in this study. There were 2254 (64.6%) men and 1235 (35.4%) were women. Age of the patients ranged from 25 to 100 years with a mean age of 62.9 ± 11.14 years. Mean ejection fraction of patients was 59.3 ± 2.57%. The indication for PPM implantation was complete heart block in 2079 (59.6%), sick sinus syndrome in 422 (12.1%), Mobitz type 2 heart block in 345 (9.9%), symptomatic left bundle branch block in 295 (8.5%), symptomatic bifasicular block in 176 (5.0%), symptomatic trifascicular block in 109 (3.1%), vasovagal syncope with symptomatic sinus bradycardia in 21 (0.6%), left anterior hemiblock with syncope in 3 (0.1%), and atrial fibrillation with heart block in 11 (0.3%) patients. Cardiac syncope was presented in 80%, presyncope in 15%, and 5% presented with features of chronotropic incompetence. No significant seasonal variation was observed in the incidence of PPM implantation. Single-chamber PPM was implanted in 58.8% and dual-chamber PPM in 41.2% of the cases. PPM-related complications were seen in 139 (3.98%) of the cases. Pneumothorax was seen in 21 (0.6%) of the cases, lead displacement in 39 (1.12%), lead replacement in 31 (0.89%), pocket site infection in 20 (0.57%), generator extrusion in 25 (0.70%), and lead extrusion in 3 (0.08%). Conclusion Conduction disorders affect men more than women and complete heart block is the most common form of conduction disorder in our population. There has been a significant improvement in bradyarrhythmia detection and its management, leading to wider penetration and safety of device therapy provided to the patient population.