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. 2021 Oct 13;28(4):43.
doi: 10.5837/bjc.2021.043. eCollection 2021.

Pain during cardiac implantable electronic device implantation

David G Wilson  1 , Nicki Brewster  2 , Robin J Taylor  1 , Amelia Trevelyan  3 , Michail Apostolakis  1 , Deepak Goyal  1 , Will Foster  1 , Elaine Walklet  4 , Eleanor Bradley  5
Affiliations

Pain during cardiac implantable electronic device implantation

David G Wilson et al. Br J Cardiol. .

Abstract

In order to evaluate the extent and causes of pain during cardiac implantable electronic device (CIED) implantation in our hospital, a prospective audit over a 23-month period using a patient selfreporting questionnaire was undertaken. In total, 599 procedures were reported, 52.9% for de novo pacemaker implantation and 23.4% for high-energy devices (cardiac resynchronisation therapy defibrillator [CRT-D], implantable cardiac defibrillator [ICD], subcutaneous ICD). Overall, the median pain score was 2/10 (interquartile range 2-4). In total, 61.6% (367/599) reported no pain or mild pain (pain scores 0-3/10), 27.7% (165/599) reported moderate pain (pain score of 4-6/10) and 10.7% (64/599) reported severe pain (pain score of 7-10/10) during the procedure. Significant preimplant worry (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.22 to 3.73) and higher lidocaine doses (OR 1.06, 95%CI 1.00 to 1.11) were associated with severe patient-reported pain. In conclusion, most patients underwent CIED implantation with minimum stress and maximum comfort. An important minority reported severe pain during the procedure. Optimising surgical technique and interventions targeted at reducing pre- and peri-implant worry, particularly in women, and especially in those receiving ICDs, warrants further investigation to reduce patient-reported pain during CIED implantation.

Keywords: anxiety; cardiac implantable electronic device; implantable cardioverter defibrillator; pain.

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Conflict of interest statement

Conflicts of interest: DW reports grants from Boston Scientific ISR Lite Grant, personal fees from Novartis, personal fees from Astrazeneca, other from Medtronic, outside the submitted work. All other authors: none.

Figures

Figure 1.
Figure 1.. Patient-reported level of worry prior to procedure
Figure 2.
Figure 2.. Patient-reported level of pain during the procedure
Figure 3.
Figure 3.. Relationship between patient-reported pre-implant worry and patient-reported pain scores
See this image and copyright information in PMC

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