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Shaik A, Rojulpote M, Roma N, Patel N, Sattar Y, Thyagaturu H, Chobufo MD, Bansal R, Alharbi A, Taha A, Raina S, Gonuguntla K. Procedural and cardiovascular outcomes of geriatric vs non-geriatric patients undergoing permanent pacemaker implantation - a nationwide cohort analysis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:128-135. [PMID: 38764544 PMCID: PMC11101956 DOI: 10.62347/firv6475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Permanent pacemaker implantation is increasing exponentially to treat atrio-ventricular block and symptomatic bradyarrhythmia. Despite being a minor surgery, immediate complications such as pocket infection, pocket hematoma, pneumothorax, hemopericardium, and lead displacement do occur. METHODS The Nationwide Inpatient Sample was queried from 2016 to 2018 to identify patients with pacemakers using ICD-10 procedure code. The Chi-square test was used for statistical analysis. RESULTS The sample size consisted of 443,460 patients with a pacemaker, 26% were <70 years (male 57%, mean age of (60.6±9.7) yr, Caucasian 70%) and 74% were ≥70 years (male 50%, mean age of (81.4±5.9) yr, Caucasian 79%). Upon comparison of rates in the young vs elderly: mortality (1.6% vs 1.5%; P<0.01), obesity (26% vs 13%; P<0.001), coronary artery disease (40% vs 49%; P<0.001), HTN (74% vs 87%; P<0.01), anemia (4% vs 5%; P<0.01), atrial fibrillation (34% vs 49%; P<0.01), peripheral artery disease (1.7% vs 3%; P<0.01), CHF (31% vs 39%; P<0.001), diabetes (31% vs 27.4%; P<0.01), vascular complications (1.1% vs 1.2%; P<0.01), pocket hematoma (0.5% vs 0.8%; P<0.01), AKI (16% vs 21%; P<0.01), hemopericardium (0.1% vs 0.1%; P = 0.1), hemothorax (0.3% vs 0.2%; P<0.01), cardiac tamponade (0.4% vs 0.5%; P<0.01), pericardiocentesis (0.4% vs 0.4%; P<0.01), cardiogenic shock (4% vs 2.3%; P<0.01), respiratory complications (1.9% vs 0.9%; P<0.01), mechanical ventilation (5.1% vs 2.9%; P<0.01); post-op bleed (0.5% vs 0.3%; P<0.01), need for transfusion (4.8% vs 3.8%; P<0.01), severe sepsis (0.6% vs 0.5%; P<0.01 ), septic shock (2% vs 1%; P<0.01), bacteraemia (0.8% vs 0.4%; P<0.01), lead dislodgement (1.4% vs 1.1%; P<0.01). CONCLUSIONS Our study revealed that the overall complication rates were lower in the elderly despite higher co-morbidities. This aligns with previous studies which showed lower rates in the elderly. Hence providers should not hesitate to provide guideline driven pacemaker placement in the elderly especially in patients with good life expectancy.
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Affiliation(s)
- Ayesha Shaik
- Department of Cardiovascular Medicine, Hartford HospitalHartford, CT, USA
| | | | - Nicholas Roma
- Department of Internal Medicine, St. Luke’s University Health NetworkBethlehem, PA, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical CenterWoonsocket, RI, USA
| | - Yasar Sattar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
| | - Harshith Thyagaturu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
| | - Muchi Ditah Chobufo
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
| | - Raahat Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
| | - Anas Alharbi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
| | - Amro Taha
- Department of Medicine, Weiss Memorial HospitalChicago, IL, USA
| | - Sameer Raina
- Department of Cardiovascular Medicine, Stanford College of MedicineStanford, CA, USA
| | - Karthik Gonuguntla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia UniversityMorgantown, WV, USA
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Morton MB, William J, Kistler PM, Prabhu S, Sugumar H, Brink OVD, Patel H, Mariani J, Voskoboinik A. Caudal fluoroscopic guidance for the insertion of transvenous pacing leads. J Cardiovasc Electrophysiol 2024; 35:433-437. [PMID: 38205869 DOI: 10.1111/jce.16183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Pneumothorax is a well-recognized complication of cardiac implantable electronic device (CIED) insertion. While AP fluoroscopy alone is the most commonly imaging technique for subclavian or axillary access, caudal fluoroscopy (angle 40°) is routinely used at our institution. The caudal view provides additional separation of the first rib and clavicle and may reduce the risk of pneumothorax. We assessed outcomes at our institution of AP and caudal fluoroscopic guided pacing lead insertion. METHODS Retrospective cohort study of consecutive patients undergoing transvenous lead insertion for pacemakers, defibrillators, and cardiac resynchronization therapy devices between 2011 and 2023. Both de novo and lead replacement/upgrade procedures were included. Data were extracted from operative, radiology, and discharge reports. All patients underwent postprocedure chest radiography. RESULTS Three thousand two hundred fifty-two patients underwent insertion of pacing leads between February 2011 and March 2023. Mean age was 71.1 years (range 16-102) and 66.7% were male. Most (n = 2536; 78.0%) procedures used caudal guidance to obtain venous access, while 716 (22.0%) procedures used AP guidance alone. Pneumothoraxes occurred in five (0.2%) patients in the caudal group and five (0.7%) patients in the AP group (p = .03). Subclavian contrast venography was performed less frequently in the caudal group (26.2% vs. 42.7%, p < .01). CONCLUSION Caudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.
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Affiliation(s)
- Matthew B Morton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeremy William
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Hitesh Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Justin Mariani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
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Knorr D, Bandorski D, Bogossian H, Iliodromitis K, Schiedat F, Karosiene Z, Mijic D, Lemke B, Seyfarth M, Voß S, Knippschild S, Aweimer A, Zarse M, Kloppe A, Botsios S. Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up. J Clin Med 2024; 13:1044. [PMID: 38398357 PMCID: PMC10888737 DOI: 10.3390/jcm13041044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. METHODS Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. RESULTS In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). CONCLUSIONS The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.
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Affiliation(s)
- Dario Knorr
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Harilaos Bogossian
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Zana Karosiene
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Dejan Mijic
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Bernd Lemke
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Melchior Seyfarth
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany
| | - Sabrina Voß
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
| | - Markus Zarse
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Axel Kloppe
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Spiridon Botsios
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
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Markos S, Nasir M, Ahmed M, Abebe S, Amogne MA, Tesfaye D, Mekonnen TS, Getachew YG. Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study. Int J Gen Med 2024; 17:93-103. [PMID: 38226183 PMCID: PMC10789569 DOI: 10.2147/ijgm.s448135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
Background A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications. Results The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.
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Affiliation(s)
- Sura Markos
- Internal Medicine Department, Hawassa University, Hawassa, Ethiopia
| | - Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | - Sintayehu Abebe
- Internal Medicine Department, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Demu Tesfaye
- Internal Medicine Department, Addis Ababa University, Addis Ababa, Ethiopia
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Howard TS, Vinocur JM. Translation of Tools and Techniques from the Adult Electrophysiology World to Pediatric Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2023; 15:515-525. [PMID: 37865524 DOI: 10.1016/j.ccep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This article reviews various opportunities to translate established and novel tools and techniques used in adult electrophysiology to pediatrics and the adult congenital heart disease population. There is a specific focus on preoperative management of special population, implantation techniques, and postoperative programming of devices.
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Affiliation(s)
- Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030, USA.
| | - Jeffrey M Vinocur
- Department of Pediatrics, Division of Pediatric Cardiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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Korsunsky DV, Utina TG, Dzhioeva ON, Drapkina OM. Experience in the use of focused lung ultrasound in the intensive care practice. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Surgical interventions, accompanied by a subclavian vein cannulation, are associated with the risk of pneumothorax. Timely detection of this condition reduces the risk of secondary complications. An effective and promising method for the early detection of pneumothorax is lung ultrasound.Aim. To evaluate the routine bedside use of focused lung ultrasound in the early postoperative period in patients after surgical interventions accompanied by subclavian vein cannulation.Material and methods. This retrospective analysis of 304 case records of patients after surgical interventions accompanied by subclavian vein cannulation was carried out. Patients underwent lung auscultation, lung ultrasound according to the Bedside Lung Ultrasound in Emergency (BLUE) protocol 1 and 6 hours after surgery, or unscheduled with a saturation decrease <90%, the appearance of shortness of breath and/or chest pain. When pneumothorax signs were detected, patients underwent an emergency chest x-ray, and an elective x-ray was performed 1 day after the intervention.Results. 304 case records were analyzed, lung ultrasound was performed in 187 (61,5%) men and 117 (38,5%) women. In 8 (2,63%) patients, 1 hour after surgery, an A-profile without lung sliding was detected. In 3 (0,99%) patients, auscultatory breathing weakening was noted, complaints of discomfort and pain during inspiration were noted by 5 (1,64%) patients. In all 8 patients, the diagnosis was confirmed by x-ray. In 5 (1,64%) patients, a mild pneumothorax was detected, which did not require drainage, while 3 patients underwent pleural drainage.Conclusion. Focused lung ultrasound using the BLUE protocol significantly improves the safety profile of patients after subclavian vein puncture, providing high levels of sensitivity and specificity in detecting pneumothorax.
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Affiliation(s)
- D. V. Korsunsky
- National Medical Research Center for Therapy and Preventive Medicine
| | - T. G. Utina
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. N. Dzhioeva
- National Medical Research Center for Therapy and Preventive Medicine; A.I. Evdokimov Moscow State University of Medicine and Dentistry
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Editorial Comment to: Perioperative complications after pacemaker implantation: Higher complication rates with subclavian vein puncture than with cephalic vein cut-down (Hasan et al.). J Interv Card Electrophysiol 2022; 66:811-813. [PMID: 35501623 DOI: 10.1007/s10840-022-01221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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