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Review
. 2025 Mar 18;14(6):2058.
doi: 10.3390/jcm14062058.

Long-Term Complications Related to Cardiac Implantable Electronic Devices

Jamie Simpson  1 , Mason Yoder  1 , Nathaniel Christian-Miller  1 , Heather Wheat  2 , Boldizsar Kovacs  2 , Ryan Cunnane  2 , Michael Ghannam  2 , Jackson J Liang  2
Affiliations
Review

Long-Term Complications Related to Cardiac Implantable Electronic Devices

Jamie Simpson et al. J Clin Med. .

Abstract

Cardiac implantable electronic devices (CIEDs) are commonly used for a number of cardiac-related conditions, and it is estimated that over 300,000 CIEDs are placed annually in the US. With advances in technology surrounding these devices and expanding indications, CIEDs can remain implanted in patients for long periods of time. Although the safety profile of these devices has improved over time, both the incidence and prevalence of long-term complications are expected to increase. This review highlights pertinent long-term complications of CIEDs, including lead-related issues, device-related arrhythmias, inappropriate device therapies, and device-related infections. We also explore key clinical aspects of each complication, including common presentations, patient-specific and non-modifiable risk factors, diagnostic evaluation, and recommended management strategies. Our goal is to help spread awareness of CIED-related complications and to empower physicians to manage them effectively.

Keywords: CIED; CIED infection; CIED-related arrhythmias; cardiac implantable electronic devices; lead-related complications; long-term complications.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overview of cardiac anatomy and CIED structure. Example of dual-chamber PPM. RA = right atrium; RV = right ventricle.
Figure 2
Figure 2
Example of ICD with defibrillator coil along RV lead.
Figure 3
Figure 3
Examples of CIED structure and lead placement; (A) single-chamber PPM with RV lead placement; (B) single-chamber PPM with RA lead placement; (C) dual-chamber PPM with RA and RV lead placement; (D) biventricular PPM with LV lead placed in coronary sinus.
Figure 4
Figure 4
Algorithmic approach for diagnostic evaluation of lead-associated venous occlusion (reproduced with permission from Zimetbaum et al., J. Am. Coll. Cardiol.; published by Elsevier, 2022) [59].
Figure 5
Figure 5
Hazard ratios of pacing-induced cardiomyopathy (PiCM) and PiCM survival curves based on predictors; (A) forest plot of hazard ratios of PiCM predictors; (B–E) Kaplan–Meier curves of individual and combined predictors, including left bundle branch block (LBBB), paced QRS duration (pQRSd) ≥ 155 ms, and right ventricular pacing percentage (RV-P%) ≥ 86% (reproduced with permission from Cho et al., Eur. J. Heart Fail.; published by Wiley, 2019) [96].
Figure 6
Figure 6
Examples of CSP: (A) left bundle branch pacing (LBBP) with RV lead located along intraventricular septum near left bundle branch; (B) His bundle pacing with RV lead located along intraventricular septum near His bundle.
Figure 7
Figure 7
Trends in annual CIED-related infection rate from 1993 to 2008 (reproduced with permission from Greenspon et al., J. Am. Coll. Cardiol.; published by Elsevier, 2011) [212].
See this image and copyright information in PMC

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