Prospective Evaluation of Complications in Pectoral and Shoulder Areas in Patients with Implanted Devices (PPM, ICD, and ICD-CRT)

Shoulder pain and disability in the implantation site is a common complication of cardiac rhythm device implantation, yet very little information is available on cardiac pacing-related complications, with most of the existing data no longer valid for current practice and recent reports focusing on some specific complications and other early complications. This prospective study recruited 404patients who received permanent endocardial devices between October2011 and 2012 in our tertiary center. The demographic and clinical characteristics of the study population as well as the complications of the devices implanted, namely the permanent pacemaker (PPM), the implantable cardioverter defibrillator (ICD), and ICD- cardiac resynchronization therapy (ICD-CRT), were evaluated and followed up. Totally, 404 patients, including 239(59.2%) males, at a mean age of 62.2± 16.7 years were enrolled. Pain was reported by 202(84.5%) of the male and 151(91.5%) of the female. Of the 353 patients, who reported pain, 336(95.2%) had horizontal incisions (p<0.001) and 332(94.1%) did not use anti-anxiety drugs (p=0.003). There were 55 smokers, among whom 53(96.4%) had pain (p=0.03). Addiction was reported by 39 (9.7%) patients. Suture line pain was reported by 295(73%), hematoma by 105(26%), pneumothorax by 3(0.7%), infection by 5(1.2%), and shoulder immobility by 110(27.2%) patients. No significant relationship was found between pain and the device type (p=0.1), pain and pneumothorax (p=1), pain and hematoma (p=0.07), pain and addiction (p=1), and pain and neurological disorders (p=0.7).The PPM was implanted in 167(41.3%), the ICD in 146(36.1%), and the ICD-CRT in 87(21.5%) patients. Suture line pain was reported by 127(76%) of the PPM patients and165(70.8%) of the ICD and the ICD-CRT patients (p=0.2). Shoulder pain was reported by 37(22.2%) of the PPM patients and 39(16.8%) of the ICD and ICD-CRT patients (p=0.1). Among those with shoulder pain, 87.2% had pain during12 hours, 84.4% during 24 hours, and 94.2% after 24 hours of immobility (p=0.2). Shoulder pain was reported in 31.4% of the patients with immobility lasting for more than 24 hours. Also,201(23%) of the patients with impaired shoulder mobility for 12 hours reported no pain. There were 241 cases with shoulder immobility lasting for 12 hours; of this total, 235 (97.5%) patients reported no movement limitation (p<0.001). Totally, 352 (99.7%) cases reported pain at 2 weeks’ follow-up (p<0.001), 198(56.3%) at one and 2 months’ follow-up (p<0.001), and 280 (79.3%) at 6 months’ follow-up (p<0.001). Shoulder pain and other disabilities often occur following cardiac rhythm management by device implantation. Understanding pain incidence related to device implantation can confer an earlier and better detection of complications.