“It’s just a generator change”

Cardiac devices are battery powered.  Like your TV remote, they require change–every 5-10 years or so.

No worries…”it’s just a generator change” is a phrase one hears frequently in the cath lab. They are supposed to be easy cases.

But they are not always.  And here is more recent evidence that the simple pacemaker/defibrillator replacement surgery—especially if a new lead is required—is more complicated than meets the eye.

In this report published in Circulation from 72 academic and private centers, major complications occurred in 4% (of a thousand) of patients who underwent generator change, and in a breathtaking 15% of those undergoing generator change with a new lead. Although there were no peri-procedure deaths, eight patients who died in the follow-up period were deemed “peri-procedural.”

When high complication rates are reported, doctors in the field, especially those in the sweet-spot of their practice years, would like to think their complication rates are lower. They may be, or they may not be. The data is the data.

The authors should be commended for reporting such humbling data. This is an important report, for both doctors and patients alike.

It reinforces my long-held view that ICDs are not like insurance policies. They carry substantial, and much under-estimated risk.

JMM