Temporal Trends in Cardiovascular Implantable Electronic Device Implants and Upgrades in the US Between 2016-2019: Insights from the National Inpatient Database

Background: Cardiovascular implantable electronic device (CIED) technology continue to advance and improve overtime to help in the treatment of various bradyarrhythmia and prevent sudden cardiac death. Trends and types of various CIED insertion has been changing over the past two decades. No recent study has captured trends in procedures related to several categories of implantable devices in United States (US) subgroups. Objective: We conducted a nationwide subcategory analysis of trends in device implants from 2016 to 2019 using the US National Inpatient Sample (NIS) database. Methods: : We used data from the NIS between January 2016 to December 2019 on hospitalized adults ≥18 years old undergoing CIED implants and/or device upgrades to study CIED device trends each year stratified by baseline characteristics and comorbid conditions. Linear regression for continuous outcomes and logistic regression for categorical outcomes were used to calculate p-value trends for each subcategory. Results: : We found a significant increase in implantation rates of all CIEDs in the US from 2016 to 2019 (150,370 to 159,300). There was a significant increase in dual-chamber compared to single-chamber pacemaker and implanted cardioverter defibrillator devices implanted noted (p <0.001), and an increase in permanent pacemaker to cardiac resynchronization therapy pacemaker upgrades from 1,280 to 1,615 (p = 0.002). When stratified by gender, the percentage of all CIEDs were higher in males than females. No significant change was shown when stratified by age, race, or comorbidity. Conclusion: The findings likely mirror the increasing prevalence of conduction abnormalities in the US and account for the better understanding that dual pacing better emulates normal cardiac physiology and atrioventricular synchrony .