Cardiac Implantable Electronic Device Procedure Trends, Clinical Indications, and In-Hospital Outcomes at a Tertiary Cardiac Center in Pakistan: A Seven-Year Registry-Based Analysis

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Objective: This study aimed to characterize the demographic profile, procedural trends, clinical indications, immediate procedural success, and in-hospital complications of cardiac implantable electronic devices (CIEDs)-related procedures performed during a seven-year institutional experience at a tertiary care center in Sukkur, Pakistan. Methodology: This retrospective descriptive registry-based analysis included consecutive CIED-related procedures performed between June 2018 and July 2025. The procedure was defined as the unit of analysis and included primary device implantation as well as generator replacement, lead revision/readjustment, device upgrade, and device extraction/wound debridement. Of 1,825 procedural records screened, 8 (0.4%) were excluded because of missing critical information regarding the primary indication and/or procedural outcome, leaving 1,817 procedures for complete-case analysis. Data were obtained from the institutional electronic registry and associated clinical records. Results: A total of 1,817 CIED procedures were included, of which 1,001 (55.1%) were performed in male patients and 816 (44.9%) in female patients. The mean age at the time of procedure was 58.7 ± 14.5 years. Single-chamber ventricular-based pacemakers were the most frequently recorded procedure category (n=964, 53.1%), followed by dual-chamber pacemakers (n=500, 27.5%) and single-chamber ICDs (n=144, 7.9%). Symptomatic complete heart block was the predominant primary indication (n=1,245, 68.5%), followed by high-degree atrioventricular block (n=237, 13.0%). The immediate procedural success rate was 100% (1,817/1,817). In-hospital complications were recorded in 33 procedures (1.8%); lead dislodgement was the most frequent complication (n=13, 0.7%), followed by pneumothorax (n=5, 0.3%) and deep vein thrombosis (n=5, 0.3%). Cardiac perforation/tamponade and infection each occurred in 4 procedures (0.2%). Two in-hospital deaths (0.1%) were recorded, one associated with severe haemothorax and one with cardiac perforation/tamponade. Conclusion: Over seven years, single-chamber ventricular-based pacemaker procedures constituted the largest proportion of CIED interventions at this tertiary cardiac satellite center, with symptomatic complete heart block representing the predominant primary indication. Immediate procedural success was recorded in all included procedures, while in-hospital complications and mortality occurred in 1.8% and 0.1% of procedures, respectively.

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