Skin Closure Techniques After Cardiac Implantable Electronic Device Implantation and Their Impact on Pocket Complications: A Systematic Review and Meta-Analysis.

BACKGROUND

Cardiac implantable electronic device (CIED) implantation, including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy systems, is increasingly performed worldwide. Despite advances in implantation techniques, device pocket-related complications such as infection, hematoma, and wound dehiscence remain clinically important. The optimal skin closure technique for preventing these complications remains uncertain.

OBJECTIVE

To evaluate and compare the safety and effectiveness of different skin closure techniques following CIED implantation.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CINAHL were searched from database inception to March 2026. Studies evaluating wound closure techniques after CIED implantation were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Primary outcomes included pocket infection, hematoma, and wound dehiscence.

RESULTS

Nine studies involving 1616 patients were included. Closure methods evaluated included conventional sutures, cyanoacrylate tissue adhesives, skin staplers, and noninvasive closure devices. Pooled analysis showed no significant difference in pocket infection between closure techniques (OR 0.91, 95% CI 0.58-1.42; p = 0.68; I2 = 29%). Similarly, no significant differences were observed for pocket hematoma (OR 1.08, 95% CI 0.67-1.74; p = 0.74; I2 = 34%) or wound dehiscence (OR 1.14, 95% CI 0.52-2.51; p = 0.75; I2 = 21%).

CONCLUSION

Different wound closure techniques following CIED implantation demonstrate comparable safety outcomes. Closure method selection may therefore be guided by operator preference, procedural efficiency, and cosmetic considerations.