Trends in Cardiac Tamponade Among Recipients of Permanent Pacemakers in the United States: From 2008 to 2012

Objectives: The aim of this study was to describe the trends and predictors of cardiac tamponade among permanent pacemaker (PPM) recipients in the United States between 2008 and 2012.

Background: Limited data exist regarding the burden, trend, and predictors of tamponade in patients following PPM implantation.

Methods: The National (Nationwide) Inpatient Sample database was used to identify PPM implantations between 2008 and 2012.

Results: Among 922,549 patients who received PPM devices between 2008 and 2012, cardiac tamponade occurred in 2,595 patients (0.28%). Overall, in-hospital cardiac tamponade rates increased by 35% among recipients of PPMs. The incidence rate steadily increased from 0.26% in 2008 to 0.35% in 2012 (p < 0.0001). Although the mean age (p = 0.28) and sex distribution (p = 0.25) did not change over the years, the rate of in-hospital mortality increased among patients who developed tamponade from 2008 to 2012 (p = 0.014). After multivariate adjustment for patient and hospital characteristics, female sex (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.04 to 1.54; p = 0.011), dual-chamber pacemakers (OR: 1.68; 95% CI: 1.17 to 2.41; p < 0.004), and chronic liver disease (OR: 3.18; 95% CI: 1.92 to 5.64; p < 0.001) were found to be independently associated with a greater odds of cardiac tamponade. Conversely, hypertension (OR: 0.71; 95% CI: 0.45 to 0.94; p = 0.021) and atrial fibrillation (OR: 0.78; 95% CI; 0.61 to 0.96; p = 0.002) were associated with lower odds of tamponade.

Conclusions: The burden of cardiac tamponade associated with PPM implantation has steadily increased in the United States. Specific patient factors were identified that could predict the risk for developing tamponade among PPM recipients.