OBJECTIVES: Manipulation of the heart during cardiac surgery in patients with cardiac implantable electronic devices may result in lead damage or -displacement, but whether cardiac surgery truly infers an excess risk of lead failure is not known. The objective of this study was to examine risk of lead complications after cardiac surgery in patients with cardiac implantable electronic devices.

METHODS AND RESULTS: We conducted a nationwide nested case-control study. The source population comprised all Danish patients ≥18 of age who underwent a de novo cardiac implantable electronic device implantation during 1998-2017. For inclusion, patients had to be alive and event-free 6 months after implantation. Cases were matched 1:30 to controls on time, age, sex and device type using risk set sampling. We used conditional logistic regression to estimate incidence rate ratios (IRRs) for the association between cardiac surgery and lead-related reoperation.

RESULTS: Our final population consisted of 67,621 patients. We identified 1437 (2.1%) incident cases of lead-related reoperations and 42,698 controls. Risk of lead complications was highest within six months of cardiac surgery (IRR 9.7, 95% CI 6.3-14.8, adjusted IRR 9.6, 95% CI 6.2-14.7), and at one year, the relative risk of lead-related reoperation was close to unity (adjusted IRR 1.2, 95% CI 0.8-1.7).

CONCLUSION: Cardiac surgery was associated with a considerable risk of lead complications in patients with de novo cardiac implantable electronic devices.