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Implanting foreign bodies in people carries an inherent risk of infection, increasing morbidity, mortality, and costs to the patient and the health care system. Many Australians have implanted pacemakers and defibrillators (cardiac implantable electronic devices, CIEDs), and the changing demographic characteristics of our population, including substantial rises in the numbers of people in their eighth to tenth decades of life, is increasing the demand. However, the benefits and risks of CIEDs warrant frank discussions prior to their insertion so that people can make informed decisions about whether they wish to proceed. There is no alternative to class 1 implants (when the pacemaker is deemed beneficial and necessary), but for class 2 implants (placement of a pacemaker is indicated, but there is conflicting evidence or divergence of opinion) this discussion is very important. Both early and late complications are possible. Major early complications include pneumothorax, pericardial effusion, lead dislodgement, and infection. One of the most serious and life‐threatening late complications is pacemaker‐related infection, particularly pacemaker lead endocarditis.

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Author: William F Heddle AM

Article Type: Editorial