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Peters GW, Patel HP, France J, Mazimba S, Deshmukh A, Dani SS, Haines DE, Mehta NK. Predictors of pocket hematoma formation after cardiac implantable electronic device procedures and the role of subcutaneous heparin. Heart Rhythm 2024:S1547-5271(24)02728-0. [PMID: 38885752 DOI: 10.1016/j.hrthm.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Garrett W Peters
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Harsh P Patel
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Josh France
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Sula Mazimba
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia; Advanced Heart Failure and Transplant Cardiology, AdventHealth Medical Group Transplant Institute, Orlando, Florida
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David E Haines
- Department of Cardiovascular Medicine, Corewell William Beaumont University Hospital, Royal Oak, Michigan
| | - Nishaki K Mehta
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; Department of Cardiovascular Medicine, Corewell William Beaumont University Hospital, Royal Oak, Michigan; Adjunct Faculty, University of Virginia, Charlottesville, Virginia.
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Walker TJ, Bradbury A. A Primer on Pacemakers and Defibrillators for Nurses. Nurs Clin North Am 2023; 58:405-419. [PMID: 37536789 DOI: 10.1016/j.cnur.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Although the concepts of pacing have been around for more than half a century, technological advances in cardiac implantable electronic devices (CIEDs) have changed the landscape for patients in need of pacing support or sudden death prevention. Nurses encounter patients with CIEDs in all aspects of the health care setting. Because exciting CIED therapies are on the horizon, nurses must stay up-to-date to promote optimal outcomes for CIED patients. This essential guide provides nurses with a comprehensive overview of the principles of pacing and implantable cardioverter defibrillators (ICDs), as well as innovative technologies such as leadless cardiac pacemakers and subcutaneous ICDs.
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Affiliation(s)
- T Jennifer Walker
- Department of Cardiac Electrophysiology, University of North Carolina, 100 Eastowne Drive, Chapel Hill, NC 27514, USA.
| | - Anderson Bradbury
- Department of Cardiac Electrophysiology, University of North Carolina, 100 Eastowne Drive, Chapel Hill, NC 27514, USA
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Lowe M, Nguyen L, Patel DJ. A Review of the Recent Advances of Cardiac Pacemaker Technology in Handling Complications. J Long Term Eff Med Implants 2023; 33:21-29. [PMID: 37522582 DOI: 10.1615/jlongtermeffmedimplants.2022039586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The total number of annual pacemaker implantations continues to grow globally, and help patients with heart rhythm disorders with an improved quality of life and reduced mortality. The first implantable pacemakers appeared in 1965, characterized by their bulkiness, short battery life, and a single pacing mode. Innovation led to the modern pacemaker: a smaller system with improved battery life and capacity, and innovation in lead technology. Certain arrhythmia conditions may also qualify for leadless pacemaker implantation, thus eliminating the spectrum of complications that could occur with leads. Adverse events can be divided into acute (perforation, lead dislodgement, infection) and long-term (lead fractures, device infection, insulation failure). Traditional long-term complications with leads occur in 10% of patients, compared with device-related adverse effects observed in 6.7% of leadless pacemakers. Furthermore, cardiac pacemaker implantation results in quality of life improvements across all age groups. Large cardiac rehabilitation studies have demonstrated the effectiveness of exercise in reducing the physical complications involved with pacemaker implantation. Of the three randomized controlled trials examined, all of them reported some benefit of exercise in the intervention group compared with the control. The following review aims to discuss the multitude of pacemaker options potentially available for the clinician, complications, their course of management, and the path forward with innovations arising out of previous research within the field.
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Affiliation(s)
- Megan Lowe
- Department of Public Health, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Lily Nguyen
- Department of Public Health, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Dhiman J Patel
- Departments of Kinesiology and Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4L9, Ontario, Canada
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Fensman SK, Grove EL, Johansen JB, Jørgensen OD, Frausing MHJP, Kirkfeldt RE, Nielsen JC. Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study. J Arrhythm 2022; 38:748-755. [PMID: 36237873 PMCID: PMC9535764 DOI: 10.1002/joa3.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Clinically significant pocket hematoma (CSH) is a common complication to cardiac implantable electronic device (CIED) surgery. We aimed to evaluate predictors of CSH after CIED surgery. Methods We performed a nationwide population-based prospective cohort study with systematic patient chart review of all Danish patients undergoing CIED surgery during a 12-month period. Multiple logistic regression analysis was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for association between predictors and CSH. Results We included 5918 consecutive patients, 63% males, mean age 72.6 years. A total of 148 (2.5%) patients experienced CSH, including 10 patients (0.2%) requiring re-operation with hematoma evacuation. The risk of CSH was significantly increased in patients treated with aspirin (aOR 1.8; 1.2-2.7), aspirin and clopidogrel (aOR 3.9; 2.3-6.5), or heparin (aOR 2.1; 1.1-4.1), and in patients with INR≥2.0 (aOR 2.0; 1.2-3.2). Patients operated by low-volume operators (aOR 2.7; 1.6-4.6) or undergoing more complex CIED surgery such as cardiac resynchronization therapy (aOR 2.0; 1.1-3.5) or dual-chamber defibrillator (aOR 2.1; 1.2-3.8) also had significantly increased CSH risk. Conclusion In a large nationwide cohort of consecutive patients undergoing CIED surgery, the risk of CSH was 2.5%, with 0.2% necessitating evacuation. CSH risk was increased both in patients receiving aspirin, dual antiplatelet therapy or continued vitamin K-antagonist therapy. Dual antiplatelet therapy had the highest risk (aOR) of CSH. Both low operator volume and more complex CIED surgery were independently associated with higher CSH risk. These data should be considered when planning CIED surgery.
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Affiliation(s)
| | - Erik Lerkevang Grove
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
| | - Jens Brock Johansen
- Department of CardiologyOdense University HospitalOdenseDenmark
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
| | - Ole Dan Jørgensen
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
- Department of Heart, Lung, and Vascular SurgeryOdense University HospitalOdenseDenmark
| | | | - Rikke Esberg Kirkfeldt
- Department of CardiologyAarhus University HospitalAarhusDenmark
- The Danish Pacemaker and ICD RegisterOdense UniversityOdenseDenmark
| | - Jens Cosedis Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
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Tarakji KG, Korantzopoulos P, Philippon F, Biffi M, Mittal S, Poole JE, Kennergren C, Lexcen DR, Lande JD, Hilleren G, Seshadri S, Wilkoff BL. Risk factors for hematoma in patients undergoing cardiac device procedures: A WRAP-IT trial analysis. Heart Rhythm O2 2022; 3:466-473. [PMID: 36340491 PMCID: PMC9626743 DOI: 10.1016/j.hroo.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Implant site hematoma is a known complication of cardiac device procedures and can lead to major consequences. Objectives To evaluate risk factors for hematoma and further understand the relationship between anticoagulant (AC), antiplatelet (AP) use, and hematoma development. Methods We included 6800 patients from the WRAP-IT trial. To assess baseline and procedural characteristics associated with hematoma within the first 30 days postprocedure, a stepwise Cox regression model was implemented with minimal Akaike information criterion. Cox regressions were also used to evaluate AC/AP use and hematoma risk. Results The overall rate of hematoma was 2.2%. The model identified 11 baseline and procedural characteristics associated with hematoma risk. AC use (hazard ratio [HR]: 2.44, P < .001), lower body mass index (HR: 1.06, P < .001), and history of valve surgery (HR: 2.11, P < .001) were associated with the highest risk. AP use, male sex, history of coronary artery disease, existing pocket, history of nonischemic cardiomyopathy, number of previous cardiac implantable electronic device (CIED) procedures, procedure time, and lead revision were associated with moderate risk. Antithrombotic use was high overall (86%) and AC+AP use was highly predictive of hematoma risk. Regardless of AC status, AP use was associated with an almost doubling of risk vs no AP (HR = 1.85, P = .0006) in the general cohort. Interruption of AC was associated with the lowest hematoma risk (HR = 2.35) while heparin bridging (HR = 4.98) and AP use vs no AP use (HR = 1.85) was associated with the highest hematoma risk. Conclusion The results of this analysis highlight risk factors associated with the development of hematoma in patients undergoing CIED procedures and can inform antithrombotic management.
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de Heide J, van der Graaf M, Holl MJ, Bhagwandien RE, Theuns DA, de Wit A, Zijlstra F, Szili-Torok T, Lenzen MJ, Yap SC. Pocket hematoma after pacemaker or defibrillator surgery: Direct oral anticoagulants versus vitamin K antagonists. IJC HEART & VASCULATURE 2022; 39:101005. [PMID: 35310376 PMCID: PMC8928071 DOI: 10.1016/j.ijcha.2022.101005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/25/2022] [Accepted: 03/12/2022] [Indexed: 11/05/2022]
Abstract
Background Direct oral anticoagulants (DOACs) are the preferred choice of oral anticoagulation in patients with atrial fibrillation (AF). Randomized trials have demonstrated the efficacy and safety of DOAC in patients undergoing a cardiac implantable electronic device procedure (CIED); however, there is limited real-world data. Objective To evaluate the outcome of patients undergoing an elective CIED procedure in a tertiary referral center with an interrupted DOAC or continued vitamin K antagonist (VKA) regimen. Methods This was a retrospective single-center study of consecutive patients with AF undergoing an elective CIED procedure between January 2016 and June 2019. The primary endpoint was a clinically significant pocket hematoma < 30 days after surgery. The secondary endpoint was any systemic thromboembolic complication < 30 days after surgery. Results Of a total of 1,033 elective CIED procedures, 283 procedures were performed in patients with AF using oral anticoagulation. One-third of the procedures were performed under DOAC (N = 81, 29%) and the remainder under VKA (N = 202, 71%). The DOAC group was younger, had less chronic renal disease, more paroxysmal AF and a lower HAS-BLED score. The VKA group more often underwent a generator change only in comparison to the DOAC group. Clinically significant pocket hematoma occurred in 5 patients (2.5%) in the VKA group and did not occur in the DOAC group (P = 0.33). There were no thromboembolic events reported. Conclusion In patients with AF undergoing an elective CIED procedure, the risk of a pocket hematoma and a systemic thromboembolic event is comparably low when using either continued VKA or interrupted DOAC.
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Implantable cardioverter-defibrillator-related procedures and associated complications in continuous flow left ventricular assist device recipients: A multicenter experience. Heart Rhythm O2 2022; 2:691-697. [PMID: 34988518 PMCID: PMC8710631 DOI: 10.1016/j.hroo.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). Objective We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LVAD cohort. Methods A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. Results Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients (P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on long-term survival (log-rank P = .7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P = .03). Conclusion Cardiac implantable electronic device-related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.
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Tarakji KG, Korantzopoulos P, Philippon F, Biffi M, Mittal S, Poole JE, Kennergren C, Lexcen DR, Lande JD, Seshadri S, Wilkoff BL. Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT trial analysis. Heart Rhythm 2021; 18:2080-2086. [PMID: 34280568 DOI: 10.1016/j.hrthm.2021.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hematoma is a complication of cardiac implantable electronic device (CIED) procedures and may lead to device infection. The TYRX antibacterial envelope reduced major CIED infection by 40% in the randomized WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention Trial) study, but its effectiveness in the presence of hematoma is not well understood. OBJECTIVE The purpose of this study was to evaluate the incidence and infectious consequences of hematoma and the association between envelope use, hematomas, and major CIED infection among WRAP-IT patients. METHODS All 6800 study patients were included in this analysis (control 3429; envelope 3371). Hematomas occurring within 30 days postprocedure (acute) were characterized and grouped by study treatment and evaluated for subsequent infection risk. Data were analyzed using Cox proportional hazard regression modeling. RESULTS Acute hematoma incidence was 2.2% at 30 days, with no significant difference between treatment groups (envelope vs control hazard ratio [HR] 1.15; 95% confidence interval [CI] 0.84-1.58; P = .39). Through all follow-up, the risk of major infection was significantly higher among control patients with hematoma vs those without (13.1% vs 1.6%; HR 11.3; 95% CI 5.5-23.2; P <.001). The risk of major infection was significantly lower in the envelope vs control patients with hematoma (2.5% vs 13.1%; HR 0.18; 95% CI 0.04-0.85; P = .03). CONCLUSION The risk of hematoma was 2.2% among WRAP-IT patients. Among control patients, hematoma carried a >11-fold risk of developing a major CIED infection. This risk was significantly mitigated with antibacterial envelope use, with an 82% reduction in major CIED infection among envelope patients who developed hematoma compared to control.
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Affiliation(s)
- Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio.
| | | | - Francois Philippon
- Electrophysiology Division, Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canada
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico Sant' Orsola, Malpighi, Italy
| | - Suneet Mittal
- Department of Cardiology, Valley Health System, Ridgewood, New Jersey
| | - Jeanne E Poole
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Charles Kennergren
- First Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | | | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Ohio
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Kewcharoen J, Kanitsoraphan C, Thangjui S, Leesutipornchai T, Saowapa S, Pokawattana A, Navaravong L. Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta-analysis. J Arrhythm 2021; 37:635-644. [PMID: 34141016 PMCID: PMC8207394 DOI: 10.1002/joa3.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Several studies have shown an inconsistent relationship between postimplantation pocket hematoma and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of postimplantation hematoma and the risk of CIED infection. METHODS We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies, and randomized controlled trials that reported incidence of postimplantation pocket hematoma and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Fourteen studies were included in final analysis, involving a total of 28 319 participants. In random-effect model, we found that postimplantation pocket hematoma significantly increases the risk of overall CIED infection (OR = 6.30, 95% CI: 3.87-10.24, I 2 = 49.3%). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger's test. CONCLUSIONS Our meta-analysis demonstrated that postimplantation pocket hematoma significantly increases the risk of CIED infection. Precaution should be taken during device implantation to reduce postimplantation hematoma and subsequent CIED infection.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency ProgramHonoluluHIUSA
| | | | | | | | - Sakditad Saowapa
- Faculty of MedicineRamathibodi HospitalMahidol UniversityBangkokThailand
| | | | - Leenhapong Navaravong
- Division of Cardiovascular MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
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Soos M, Rahman M, Laxina I, Gonzalez-Morales D, Gandhi D, Kang A, Kanjwal K. Retropectoral hematoma: A rare complication following biventricular implantable cardiac defibrillator upgrade. HeartRhythm Case Rep 2021; 7:255-258. [PMID: 34026508 PMCID: PMC8129043 DOI: 10.1016/j.hrcr.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael Soos
- McLaren Greater Lansing Hospital, Lansing, Michigan
| | | | - Ian Laxina
- McLaren Greater Lansing Hospital, Lansing, Michigan
| | | | | | - Awais Kang
- McLaren Greater Lansing Hospital, Lansing, Michigan
| | - Khalil Kanjwal
- McLaren Greater Lansing Hospital, Lansing, Michigan
- Department of Medicine, Michigan State University, East Lansing, Michigan
- Address reprint requests and correspondence: Dr Khalil Kanjwal, Director of Electrophysiology and Electrophysiology Laboratory, McLaren Greater Lansing Hospital, Lansing, MI 48901.
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Adverse Events After Inpatient Colonoscopy in Octogenarians: Inferring Procedural Adverse Events From Nonspecific Diagnosis Codes. J Clin Gastroenterol 2020; 54:388-389. [PMID: 32000166 DOI: 10.1097/mcg.0000000000001320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Song J, Tark A, Larson EL. The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: An integrative review. Heart Lung 2020; 49:92-98. [DOI: 10.1016/j.hrtlng.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 09/25/2019] [Indexed: 01/31/2023]
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Saylor PJ, Dudzinski DM, Mendoza DP, Glomski K. Case 14-2019: A 44-Year-Old Man with Neck Pain and Swelling. N Engl J Med 2019; 380:1854-1863. [PMID: 31067377 DOI: 10.1056/nejmcpc1900421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Philip J Saylor
- From the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Harvard Medical School - both in Boston
| | - David M Dudzinski
- From the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Harvard Medical School - both in Boston
| | - Dexter P Mendoza
- From the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Harvard Medical School - both in Boston
| | - Krzysztof Glomski
- From the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Massachusetts General Hospital, and the Departments of Medicine (P.J.S., D.M.D.), Radiology (D.P.M.), and Pathology (K.G.), Harvard Medical School - both in Boston
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Mukherjee SS, Saggu D, Chennapragada S, Yalagudri S, Nair SG, CalamburNarasimhan. Device implantation for patients on antiplatelets and anticoagulants: Use of suction drain. Indian Heart J 2018; 70 Suppl 3:S389-S393. [PMID: 30595295 PMCID: PMC6309121 DOI: 10.1016/j.ihj.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/21/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022] Open
Abstract
Background and objectives Cardiovascular implantable electronic devices (CIED) are frequently implanted in patients on anti-thrombotic agents. Pocket hematomas are more likely to occur in these patients. The use of a sterile surgical drain in the pulse generator pocket site could prevent hematomas, but fear of infection precludes its use. The objective of the present study is to study the safety and efficacy of surgical drain in patients on antithrombotics undergoing CIED implantations. Methods This is a single-centre, retrospective study involving patients undergoing CIED implantations on antithrombotics (antiplatelets and anticoagulants) from August 2013 to July 2016. Patients with high risk of thromboembolism were continued on oral antithrombotics or were bridged with heparin after stopping oral antithrombotics. A sterile close wound suction drain was placed in device pockets following CIED implantations. Post procedure, pressure dressing was applied and removed after 12 h once the drain volume was less than 10 ml in 24 h. Results Sixty seven patients required surgical drain implantation. Major indications for antithrombotic use were presence of intracoronary stent, atrial fibrillation and mechanical valve replacements. The mean post-procedural hospital stay was 3 ± 0.9 days and mean overall drain was 16.6 ± 8.2 ml. At a mean follow up of 17.6 ± 8.2 months, one patient (1.4%) had pocket hematoma. There were no infections. Conclusion The use of a surgical drain in CIED implantation significantly reduces the risk of hematoma formation without increasing the risk of infection. Antithrombotic drugs can be safely continued at the time of implantation of cardiac devices.
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Affiliation(s)
| | - Daljeet Saggu
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | | | - Sachin Yalagudri
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | - Sandeep G Nair
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | - CalamburNarasimhan
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India.
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Bhargava K. Identifying the predictors of hematoma after device implantation: Closing in on the suspects with an aim to prevent the menace? Indian Pacing Electrophysiol J 2016; 16:157-158. [PMID: 27979374 PMCID: PMC5153436 DOI: 10.1016/j.ipej.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022] Open
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