Pain during cardiac implantable electronic device implantation

David G Wilson; Nicki Brewster; Robin J Taylor; Amelia Trevelyan; Michail Apostolakis; Deepak Goyal; Will Foster; Elaine Walklet; Eleanor Bradley

doi:10.5837/bjc.2021.043

Pain during cardiac implantable electronic device implantation

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

Authors

David G Wilson¹, Nicki Brewster², Robin J Taylor¹, Amelia Trevelyan³, Michail Apostolakis¹, Deepak Goyal¹, Will Foster¹, Elaine Walklet⁴, Eleanor Bradley⁵

Affiliations

¹ Consultant Cardiologist Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD.
² Arrhythmia Specialist Nurse Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD.
³ Medical Student Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD.
⁴ Senior Lecturer in Psychology School of Natural and Social Sciences, Francis Close Hall Campus, University of Gloucestershire, Swindon Road, Cheltenham, Gloucestershire, GL50 4AZ.
⁵ Professor of Health Psychology, College Director of Research and Knowledge Exchange, College of Health, Life and Environmental Sciences University of Worcester, Henwick Grove, St. John's, Worcester, WR2 6AJ.

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.

Grants and funding

Funding None.