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Baldauf B, Lau EW, Giaccardi M, Bonnemeier H. An unusual cause of inappropriate shocks delivered by an implantable cardioverter defibrillator. BMC Cardiovasc Disord 2024; 24:380. [PMID: 39039491 PMCID: PMC11264391 DOI: 10.1186/s12872-024-04038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) complications present significant challenges in clinical practice, especially in elderly patients with multiple comorbidities. Common adverse events include infection, lead malfunction, and device migration. Twiddler's Syndrome, a rare but serious CIED complication characterised by patient manipulation causing lead displacement and device malfunction, is often underreported. The literature consists mainly of case reports and small series, providing limited guidance on prevention and management. As CIEDs are critical for managing cardiac arrhythmias and heart failure, understanding and addressing Twiddler's Syndrome is essential. This case report aims to contribute to the literature by detailing a case of Twiddler's Syndrome, emphasising the importance of a multidisciplinary approach for optimal management. CASE PRESENTATION A 59-year-old male presented with discomfort around his implantable cardioverter defibrillator (ICD) site and the sternal area over the past two days. He denied pain, dyspnoea, or dizziness. Clinical examination revealed a normal heart rhythm and no peripheral pulse deficit. Ultrasound revealed a reduced left ventricular ejection fraction. The atrial lead was not visible, and the shock coil was misplaced. ICD interrogation showed inappropriate shocks due to sensing artifacts and exit block in both leads, with no arrhythmias detected. An X-ray confirmed lead dislodgement and significant entanglement in the pocket. The patient was diagnosed with Twiddler's Syndrome and scheduled for surgical revision. DISCUSSION/CONCLUSIONS Dilated cardiomyopathy (DCM), characterised by left ventricular dilatation and dysfunction, accounts for a significant proportion of systolic heart failure cases. Despite advancements in heart failure management, DCM patients remain at high risk for sudden cardiac death (SCD), making ICD implantation crucial. However, CIED placement carries risks of complications, including Twiddler's Syndrome. This condition can lead to lead dislodgement and device malfunction, resulting in inappropriate shocks and potential patient harm. In this case, a single-session extraction and re-implantation were successfully performed using a multidisciplinary approach, emphasising the importance of comprehensive management strategies to address such complications effectively. Regular follow-up showed no adverse events, highlighting the procedure's success and the potential benefits of using advanced antimicrobial adjuncts to prevent infections. This case underscores the need for awareness and standardised protocols for managing Twiddler's Syndrome to improve patient outcomes in the growing population of CIED recipients.
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Affiliation(s)
- Benito Baldauf
- Christian-Albrechts-Universität, Medizinische Fakultät, Christian-Albrechts-Platz 4, 24118, Kiel, Germany.
- Hochschule Bremerhaven, Life Sciences, An d. Karlstadt 8, 27568, Bremerhaven, Germany.
| | - Ernest W Lau
- Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - Marzia Giaccardi
- Osp. Santa Maria Annunziata, Via Antella 58, Bagno a Ripoli, 50012, Italy
| | - Hendrik Bonnemeier
- Christian-Albrechts-Universität, Medizinische Fakultät, Christian-Albrechts-Platz 4, 24118, Kiel, Germany
- Hochschule Bremerhaven, Life Sciences, An d. Karlstadt 8, 27568, Bremerhaven, Germany
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Táborský M, Skála T, Dušek L, Kautzner J, Aiglová R, Fedorco M, Jarkovský J, Benešová K, Májková P. Clinical characteristics and mortality in all Czech patients after pacemaker implantation in the last decade. Front Cardiovasc Med 2023; 10:1248145. [PMID: 38144370 PMCID: PMC10739293 DOI: 10.3389/fcvm.2023.1248145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background and aims Analysis of mortality from the national health registries and data from a specific central registry dealing with the implantation of pacemakers (REPACE) in Czech patients. Methods and results Retrospective observational analysis of pacemakers' implantation in all Czech patients [n = 82,791; 47,070 (56.9%) men, 75.9 ± 10.4 years old] between 2010 and 2021. Almost 114,000 pacemakers were implanted between 2010 and 2021, of which 27.9% were single-chamber, 67.4% were dual-chamber and 4.6% were biventricular. The annual number of implantations has been steadily increasing with a 6% annual decline in 2020 with increased mortality and reductions in care provided, likely related to COVID-19. The observed 5-year relative survival was 88.6% (overall survival 60.6%) and the 10-year relative survival was 75.9% (overall survival 32.7%). Causes of death 5ary according to the age of the patient. The highest difference 1n the reported numbers in the REPACE Registry did not exceed 2% in comparison with the National Register of Reimbursed Health Services. Conclusion This study followed all Czech patients with pacemaker's implantation in between 2010 and 2021. The annual number of 1mplantations has been steadily 1ncreasing. Patients with implanted pacemakers had a significantly higher mortality than the average population. Number of patients in the registry corresponded almost perfectly with the National Register of Reimbursed Health Services.
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Affiliation(s)
- Miloš Táborský
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Tomáš Skála
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Praha, Czech Republic
| | - Josef Kautzner
- Cardiac Centre, Institute for Clinical and Experimental Medicine—IKEM, Praha, Czech Republic
| | - Renata Aiglová
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Marián Fedorco
- Department of Internal Medicine I—Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiří Jarkovský
- Institute of Health Information and Statistics of the Czech Republic, Praha, Czech Republic
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice, Czech Republic
| | - Klára Benešová
- Institute of Health Information and Statistics of the Czech Republic, Praha, Czech Republic
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice, Czech Republic
| | - Petra Májková
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice, Czech Republic
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Forman J, Murtagh E, Cheung J, Chakrabarti S, Macleod S, MacEwing C, Owens S, Alley H, Bangma K, Villeneuve M, Lauck S. Development of a patient and clinician co-led education program to promote living well with an implantable cardioverter defibrillator: Insights from a pilot project. PEC INNOVATION 2022; 1:100104. [PMID: 37213750 PMCID: PMC10194333 DOI: 10.1016/j.pecinn.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 05/23/2023]
Abstract
Objective To evaluate a pilot education program designed to improve patients' experience of living well with an implantable cardioverter-defibrillator (ICD). Methods Patient Partners with previously implanted ICD and clinicians collaboratively performed monthly education sessions for potential and recent ICD recipients. Curriculum development was informed by current evidence of ICD patients' unique educational needs; delivery format transitioned to a virtual platform following the onset of COVID-19. Participants' experience was evaluated using a tailored questionnaire to explore preliminary insights. Results 126 participants (median age: 62 years; women: 30%) attended 24 sessions. In-person participants (n = 62, 49.2%) reported sessions as helpful (n = 56, 94%) with regards to format and Patient Partner interactions. Virtual participants 64 (50.8%) completed an electronic survey (n = 27, 45%); reporting sufficient information for most topics with the exception of potential psychological effects of ICD implantation. Patient Partners as collaborative session leaders was perceived to be very helpful (n = 22, 82%) or somewhat helpful (n = 5, 18%). Conclusion This novel educational partnership met the learning needs of patients at the vulnerable time of new cardiac device implantation of both in-person and virtual formats. Innovation The inclusion of Patient Partners in co-led cardiac education informs novel approach to care that may improve patients' experiences of living well with complex technology.
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Affiliation(s)
| | | | | | - Santabhanu Chakrabarti
- St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | - Sandra Lauck
- St. Paul’s Hospital, Vancouver, Canada
- University of British Columbia School of Nursing, Vancouver, Canada
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Khurshid S, Chen W, Bode WD, Wasfy JH, Chhatwal J, Lubitz SA. Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision-Analytic Model. J Am Heart Assoc 2021; 10:e021144. [PMID: 34387130 PMCID: PMC8475040 DOI: 10.1161/jaha.121.021144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual-level simulation comprising 2 000 000 average-risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)-guided implantable cardioverter-defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality-adjusted life years (QALYs), with cardiac deaths (arrest or procedural-related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost-effectiveness at $100 000/QALY. Compared with observation, EPS-guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS-guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD-based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20-39.4 years and arrest rates >1.37%/year; EPS-guided ICD was the most effective strategy at ages 39.5-51.3 years and arrest rates 0.47%-1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS-guided subcutaneous ICD was cost-effective ($80 508/QALY). Conclusions Device-based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.
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Affiliation(s)
- Shaan Khurshid
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Wanyi Chen
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Weeranun D. Bode
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
| | - Jason H. Wasfy
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Jagpreet Chhatwal
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Steven A. Lubitz
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
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Helmers MR, Shin M, Iyengar A, Arguelles GR, Mays J, Han JJ, Patrick W, Altshuler P, Hargrove WC, Atluri P. Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes. Eur J Cardiothorac Surg 2021; 60:140-147. [PMID: 33659995 DOI: 10.1093/ejcts/ezab091] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited. METHODS Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival. RESULTS A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12-1.35), concomitant aortic (1.44; 1.10-1.90) and tricuspid valve procedures (2.21; 1.64-2.97) and prior history of myocardial infarction (1.48; 1.07-1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19-8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality. CONCLUSIONS Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.
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Affiliation(s)
- Mark R Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Max Shin
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Gabriel R Arguelles
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jarvis Mays
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - William Patrick
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Altshuler
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - W Clark Hargrove
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Smietana J, Frankel DS, Serletti JM, Arkles J, Pothineni NVK, Marchlinski FE, Schaller RD. Subserratus implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2021; 18:1799-1804. [PMID: 34119694 DOI: 10.1016/j.hrthm.2021.06.1169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jeffrey Smietana
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M Serletti
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Richardson CJ, Prempeh J, Gordon KS, Poyser TA, Tiesenga F. Surgical Techniques, Complications, and Long-Term Health Effects of Cardiac Implantable Electronic Devices. Cureus 2021; 13:e13001. [PMID: 33659133 PMCID: PMC7920239 DOI: 10.7759/cureus.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular implantable electronic device (CIED) has helped with advanced technological improvement in the cardiac field and has been a long-term alternative to medical management. There are different forms of CIEDs such as pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. These devices are efficient in establishing near-normal hemodynamics and circulation that ultimately aid physicians to improve the quality of life for their patients. However, there are risk factors that can result in postoperative complications, including infection, lead and pulse generator complications, heart complications, medication-related complications, and psychosocial complications. To ensure optimal outcome of CIED placement, preprocedural measures need to be in place such as matching the right candidate and using appropriate devices. This review aims to highlight the surgical techniques for CIEDs, the associated postoperative complications, and long-term health effects.
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Affiliation(s)
| | - John Prempeh
- Internal Medicine, Saint James School of Medicine, The Quarter, AIA
| | - Kyle S Gordon
- Internal Medicine, American University of Antigua, Osburn, ATG
| | - Tracy-Ann Poyser
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
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Leiter RE, Santus E, Jin Z, Lee KC, Yusufov M, Chien I, Ramaswamy A, Moseley ET, Qian Y, Schrag D, Lindvall C. Deep Natural Language Processing to Identify Symptom Documentation in Clinical Notes for Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. J Pain Symptom Manage 2020; 60:948-958.e3. [PMID: 32585181 DOI: 10.1016/j.jpainsymman.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT Clinicians lack reliable methods to predict which patients with congestive heart failure (CHF) will benefit from cardiac resynchronization therapy (CRT). Symptom burden may help to predict response, but this information is buried in free-text clinical notes. Natural language processing (NLP) may identify symptoms recorded in the electronic health record and thereby enable this information to inform clinical decisions about the appropriateness of CRT. OBJECTIVES To develop, train, and test a deep NLP model that identifies documented symptoms in patients with CHF receiving CRT. METHODS We identified a random sample of clinical notes from a cohort of patients with CHF who later received CRT. Investigators labeled documented symptoms as present, absent, and context dependent (pathologic depending on the clinical situation). The algorithm was trained on 80% and fine-tuned parameters on 10% of the notes. We tested the model on the remaining 10%. We compared the model's performance to investigators' annotations using accuracy, precision (positive predictive value), recall (sensitivity), and F1 score (a combined measure of precision and recall). RESULTS Investigators annotated 154 notes (352,157 words) and identified 1340 present, 1300 absent, and 221 context-dependent symptoms. In the test set of 15 notes (35,467 words), the model's accuracy was 99.4% and recall was 66.8%. Precision was 77.6%, and overall F1 score was 71.8. F1 scores for present (70.8) and absent (74.7) symptoms were higher than that for context-dependent symptoms (48.3). CONCLUSION A deep NLP algorithm can be trained to capture symptoms in patients with CHF who received CRT with promising precision and recall.
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Affiliation(s)
- Richard E Leiter
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Enrico Santus
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Zhijing Jin
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Katherine C Lee
- Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Miryam Yusufov
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Isabel Chien
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Ashwin Ramaswamy
- Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Edward T Moseley
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Yujie Qian
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Deborah Schrag
- Harvard Medical School, Boston, Massachusetts, USA; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Moskowitz G, Hong KN, Giustino G, Gillinov AM, Ailawadi G, DeRose JJ, Iribarne A, Moskowitz AJ, Gelijns AC, Egorova NN. Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery. J Am Coll Cardiol 2019; 74:2607-2620. [PMID: 31753204 PMCID: PMC7968118 DOI: 10.1016/j.jacc.2019.08.1064] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/22/2019] [Accepted: 08/25/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. OBJECTIVES The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. METHODS All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. RESULTS Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. CONCLUSIONS Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.
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Affiliation(s)
- Gil Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly N Hong
- Division of Cardiovascular Medicine, University of California, San Diego, San Diego, California
| | - Gennaro Giustino
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Joseph J DeRose
- Department of Cardiovascular and Thoracic Surgery, Montefiore-Einstein Heart Center, Bronx, New York
| | - Alexander Iribarne
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
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10
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Coutinho Cruz M, Viveiros Monteiro A, Portugal G, Laranjo S, Lousinha A, Valente B, Osório P, Silva Cunha P, de Sousa L, Oliveira JA, Agapito A, Martins Oliveira M, Pinto F, Cruz Ferreira R. Long-term follow-up of adult patients with congenital heart disease and an implantable cardioverter defibrillator. CONGENIT HEART DIS 2019; 14:525-533. [PMID: 30889316 DOI: 10.1111/chd.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/28/2018] [Accepted: 02/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sudden cardiac death is common in the adult congenital heart disease (ACHD) population. Knowledge and experience about the use of implantable cardioverter defibrillators (ICD) in ACHD patients is very limited. We aimed to characterize a cohort of patients with ACHD and ICDs. DESIGN Thirty consecutive ACHD patients submitted to an ICD implantation in a single tertiary center were evaluated. Data on baseline clinical features, heart defect, indication for ICD, type of device, appropriate therapies, ICD-related complication, and mortality during follow-up were collected. RESULTS Of the 30 patients, 56.7% received appropriate therapies due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The rate of inappropriate therapies and device-related complications was 33.3%. Secondary prevention and primary prevention patients with class I indications for ICD had more appropriate therapies than complication, but this relationship was reversed for patients with class II indications. Remote monitoring played an important role in diagnosing new atrial arrhythmias before scheduled visits in 46.2% of patients, leading to a change in medication. VT/VF episodes were associated with a composite of death, cardiac transplantation, and hospital admission (OR 13.0; 95% CI: 2.1-81.5). CONCLUSION ICDs are not only useful in preventing SCD, but also have a major role in diagnosing atrial tachyarrhythmias ahead of scheduled visits. Although improvements in ICD technology might reduce complications and inappropriate therapies, adequate selection of candidates for primary prevention still remains difficult because of the lack of clear indications.
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Affiliation(s)
- Madalena Coutinho Cruz
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Viveiros Monteiro
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sérgio Laranjo
- Pediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Lousinha
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Bruno Valente
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Paulo Osório
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Silva Cunha
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Lídia de Sousa
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - José Alberto Oliveira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Agapito
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Martins Oliveira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fátima Pinto
- Pediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Forman J, Baumbusch J, Jackson H, Lindenberg J, Shook A, Bashir J. Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2018; 17:698-706. [DOI: 10.1177/1474515118777419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.
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Thirty-day readmissions after cardiac implantable electronic devices in the United States: Insights from the Nationwide Readmissions Database. Heart Rhythm 2018; 15:708-715. [DOI: 10.1016/j.hrthm.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 11/21/2022]
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