Pioneering Efforts: Cardiac Device Implantation Trends and Variable Patient Outcomes – A Community Benefit Tool

Abstract

Objectives: To analyze trends in cardiac device implantation and interventions, along with patient outcomes, at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.

Methodology: This retrospective study was conducted from January 2017 to December 2020 at NICVD, Karachi. Patients presenting to outpatient or emergency departments with diagnoses of bradycardia (sinus node dysfunction or atrioventricular blocks), heart failure, survival of sudden cardiac death (SCD), or cardiomyopathy, and meeting the American College of Cardiology (ACC)/American Heart Association criteria for device-based therapies, were included. Data on demographic characteristics, comorbid conditions, device types, indications, and post-procedural outcomes, including complications and mortality, were collected and analyzed.

Results: A total of 5,166 cases were analyzed over the four-year study period, with 2,991 (57.9%) males and a mean age of 58.2 ± 22.4 years. Hypertension was the most prevalent comorbidity, affecting 1,872 (36.2%) patients. Dual-chamber, rate-modulated pacemakers (DDDR) were the most frequently implanted devices, accounting for 1,943 (37.6%) cases, while single-chamber implantable cardiac defibrillators (ICDs) were predominantly used for secondary prevention in ischemic heart disease. Complete heart block was the most common indication, observed in 1,794 (34.7%) patients. Post-procedural complications were infrequent, with hematoma and wound infections being the most common. Mortality was reported in 23 (0.4%) patients.

Conclusion: Dual-chamber, rate-modulated pacemakers (DDDR) emerged as the most frequently implanted pacemakers, while single-chamber ICDs were the preferred defibrillators for secondary prevention. Complete heart block was the leading indication for device implantation. Post-procedural complications, including hematoma and wound infection, were rare, and overall mortality associated with cardiac device implantation was remarkably low.