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Kamalathasan S, Paton M, Gierula J, Straw S, Witte KK. Is conduction system pacing a panacea for pacemaker therapy? Expert Rev Med Devices 2024:1-11. [PMID: 38913600 DOI: 10.1080/17434440.2024.2370827] [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: 04/04/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION While supported by robust evidence and decades of clinical experience, right ventricular apical pacing for bradycardia is associated with a risk of progressive left ventricular dysfunction. Cardiac resynchronization therapy for heart failure with reduced ejection fraction can result in limited electrical resynchronization due to anatomical constraints and epicardial stimulation. In both settings, directly stimulating the conduction system below the atrio-ventricular node (either the bundle of His or the left bundle branch area) has potential to overcome these limitations. Conduction system pacing has met with considerable enthusiasm in view of the more physiological electrical conduction pattern, is rapidly becoming the preferred option of pacing for bradycardia, and is gaining momentum as an alternative to conventional biventricular pacing. AREAS COVERED This article provides a review of the current efficacy and safety data for both people requiring treatment for bradycardia and the management of heart failure with conduction delay and discusses the possible future roles for conduction system pacing in routine clinical practice. EXPERT OPINION Conduction system pacing might be the holy grail of pacemaker therapy without the disadvantages of current approaches. However, hypothesis and enthusiasm are no match for robust data, demonstrating at least equivalent efficacy and safety to standard approaches.
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Affiliation(s)
- Stephe Kamalathasan
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Maria Paton
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
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Prevention and Management of Cardiac Implantable Electronic Device Infections: State-of-the-Art and Future Directions. Heart Lung Circ 2022; 31:1482-1492. [PMID: 35989213 DOI: 10.1016/j.hlc.2022.06.690] [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: 03/19/2022] [Revised: 06/09/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022]
Abstract
Cardiac implantable electronic device (CIED) infection is an increasingly common complication of device therapy. CIED infection confers significant patient morbidity and health care expenditure, hence it is essential that clinicians recognise the contemporary strategies for predicting, reducing and treating these events. Recent technological advances-in particular, the development of antimicrobial envelopes, leadless devices and validated risk scores-present decision-makers with novel strategies for managing this expanding patient population. This review summarises the key issues facing CIED patients and their physicians, and explores the supporting evidence for the latest therapeutic developments in this field.
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Ingelaere S, Hoffmann R, Guler I, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, le Polain de Waroux JB, Vandenberk B, Willems R. Inequality between women and men in ICD implantation. IJC HEART & VASCULATURE 2022; 41:101075. [PMID: 35782706 PMCID: PMC9240366 DOI: 10.1016/j.ijcha.2022.101075] [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: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
Background The impact of sex on ICD implantation practice and survival remain a topic of controversy. To assess sex-specific differences in ICD implantation practice we compared clinical characteristics and survival in women and men. Methods From a nationwide registry, all new ICD implantations performed between 01/02/2010 and 31/01/2019 in Belgian patients were analyzed retrospectively. Baseline characteristics and survival rates were compared between sexes. To identify predictors of mortality, multivariable Cox regression was performed. Results Only 3096 (20.9%) of 14,787 ICD implantations were performed in women. Within each type of underlying cardiomyopathy, the proportion women were lower than men. The main indication in men was ischemic vs dilated cardiomyopathy in women. Women were overall younger (59.1 ± 15.1 vs 62.6 ± 13.1 years; p < 0.001) and had less comorbidities except for oncological disease. More women functioned in NYHA-class III (33.6% vs 27.9%; p < 0.001) and had a QRS > 150 ms (29.4% vs 24.3%; p < 0.001), consistent with a higher use of CRT-D devices (31.7% vs 25.1%; p < 0.001). Women had more complications, reflected by the need to more re-interventions within 1 year (4.3% vs 2.7%, p < 0.001). After correction for covariates, sex-category was not a significant predictor of mortality (p = 0.055). Conclusion There is a significant sex-disparity in ICD implantation rates, not fully explained by epidemiological differences in the prevalence of cardiomyopathies, which could imply an undertreatment of women. Women differ from men in baseline characteristics at implantation suggesting a selection bias. Further research is necessary to evaluate if women receive equal sudden cardiac death prevention.
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Yee R, Karim SS, Bashir J, Bennett MT, Exner DV, Guerra PG, Healey JS, Korkola S, Manlucu J, Parkash R, Philippon F, Rinne C. Canadian Heart Rhythm Society Task Force Report on Physician Training and Maintenance of Competency for Cardiovascular Implantable Electronic Device Therapies: Executive Summary. Can J Cardiol 2021; 37:1857-1860. [PMID: 34571165 DOI: 10.1016/j.cjca.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022] Open
Abstract
Physicians engaged in cardiovascular implantable electronic device (CIED)-related practice come from diverse training backgrounds with variable degrees of CIED implant training. The objective of the Canadian Heart Rhythm Society Task Force on CIED Implant Training was to establish a common structure and content for training programs in CIED implantation, related activities and maintenance of competency. This executive summary presents the essence of the report with key recommendations included, with the complete version made available in a linked supplement. The goals are to ensure that future generations of CIED implanters are better prepared for continuously evolving CIED practice and quality care for all Canadians.
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Affiliation(s)
- Raymond Yee
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
| | - Shahzad S Karim
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek V Exner
- Division of Cardiac Sciences, Cardiology Section, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter G Guerra
- Division de Cardiologie, Departement de Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Korkola
- Division of Cardiac Surgery, Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Francois Philippon
- Division de Cardiologie, Departement de Medicine, Universite Laval, Ville de Quebec, Quebec, Canada
| | - Claus Rinne
- St. Mary's Regional Cardiac Care Centre, Kitchener, Ontario, Canada
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5
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Han HC, Hawkins NM, Pearman CM, Birnie DH, Krahn AD. Epidemiology of cardiac implantable electronic device infections: incidence and risk factors. Europace 2021; 23:iv3-iv10. [PMID: 34051086 PMCID: PMC8221051 DOI: 10.1093/europace/euab042] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Cardiac implantable electronic device (CIED) infection is a potentially devastating complication of CIED procedures, causing significant morbidity and mortality for patients. Of all CIED complications, infection has the greatest impact on mortality, requirement for re-intervention and additional hospital treatment days. Based on large prospective studies, the infection rate at 12-months after a CIED procedure is approximately 1%. The risk of CIED infection may be related to several factors which should be considered with regards to risk minimization. These include technical factors, patient factors, and periprocedural factors. Technical factors include the number of leads and size of generator, the absolute number of interventions which have been performed for the patient, and the operative approach. Patient factors include various non-modifiable underlying comorbidities and potentially modifiable transient conditions. Procedural factors include both peri-operative and post-operative factors. The contemporary PADIT score, derived from a large cohort of CIED patients, is useful for the prediction of infection risk. In this review, we summarize the key information regarding epidemiology, incidence and risk factors for CIED infection.
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Affiliation(s)
- Hui-Chen Han
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles M Pearman
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester M13 9XX, UK
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace 2021; 22:515-549. [PMID: 31702000 PMCID: PMC7132545 DOI: 10.1093/europace/euz246] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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7
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2021; 57:e1-e31. [PMID: 31724720 DOI: 10.1093/ejcts/ezz296] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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8
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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Comparison of new implantation of cardiac implantable electronic device between tertiary and non-tertiary hospitals: a Korean nationwide study. Sci Rep 2021; 11:3705. [PMID: 33723278 PMCID: PMC7961055 DOI: 10.1038/s41598-021-83160-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/28/2021] [Indexed: 01/09/2023] Open
Abstract
This study compared the characteristics and mortality of new implantation of cardiac implantable electronic device (CIED) between tertiary and non-tertiary hospitals. From national health insurance claims data in Korea, 17,655 patients, who underwent first and new implantation of CIED between 2013 and 2017, were enrolled. Patients were categorized into the tertiary hospital group (n = 11,560) and non-tertiary hospital group (n = 6095). Clinical outcomes including in-hospital death and all-cause death were compared between the two groups using propensity-score matched analysis. Patients in non-tertiary hospitals were older and had more comorbidities than those in tertiary hospitals. The study population had a mean follow-up of 2.1 ± 1.2 years. In the propensity-score matched permanent pacemaker group (n = 5076 pairs), the incidence of in-hospital death (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.43–1.32, p = 0.33) and all-cause death (hazard ratio [HR]: 0.92, 95% CI 0.81–1.05, p = 0.24) were not significantly different between tertiary and non-tertiary hospitals. These findings were consistently observed in the propensity-score matched implantable cardioverter-defibrillator group (n = 992 pairs, OR for in-hospital death: 1.76, 95% CI 0.51–6.02, p = 0.37; HR for all-cause death: 0.95, 95% CI 0.72–1.24, p = 0.70). In patients undergoing first and new implantation of CIED in Korea, mortality was not different between tertiary and non-tertiary hospitals.
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Shaik NA, Drucker M, Pierce C, Duray GZ, Gillett S, Miller C, Harrell C, Thomas G. Novel two-lead cardiac resynchronization therapy system provides equivalent CRT responses with less complications than a conventional three-lead system: Results from the QP ExCELs lead registry. J Cardiovasc Electrophysiol 2020; 31:1784-1792. [PMID: 32412126 PMCID: PMC7496977 DOI: 10.1111/jce.14552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
Abstract
Introduction The novel two‐lead cardiac resynchronization therapy (CRT)‐DX system utilizes a floating atrial dipole on the implantable cardioverter‐defibrillator lead, and when implanted with a left ventricular (LV) lead, offers a two‐lead CRT system with AV synchrony. This study compared complication rates and CRT response among subjects implanted with a two‐lead CRT‐DX system to those subjects implanted with a standard three‐lead CRT‐D system. Methods and Results A total of 240 subjects from the Sentus QP—Extended CRT Evaluation with Quadripolar Left Ventricular Leads postapproval study were selected to identify 120 matched pairs based on similar demographic characteristics using a Greedy algorithm. The complication‐free rate was evaluated as the primary endpoint. All‐cause mortality, heart failure hospitalizations, device diagnostic data, New York Heart Association (NYHA) class improvement, and defibrillator therapy were evaluated from clinical data, in‐office interrogations, and remote monitoring throughout the follow‐up period. Complication‐free survival favored the CRT‐DX group with 92.5% without a major complication compared to 85.0% in the CRT‐D cohort (P = .0495; 95% confidence interval: 0.1%‐14.9%) over a mean follow‐up of 1.3 and 1.4 years, respectively. Incidence of all‐cause mortality, heart failure hospitalizations, NYHA changes at 6 months postimplant, and percent of LV pacing during CRT therapy were similar in both device cohorts. Inappropriate shocks were more frequent in the CRT‐D cohort with 5.8% of subjects receiving an inappropriate shock vs 0.8% in the CRT‐DX cohort. Conclusion The results of this subanalysis demonstrate that the CRT‐DX system can provide similar CRT responses and significantly fewer complications when compared to a similar cohort with a conventional three‐lead CRT‐D system.
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Affiliation(s)
- Naushad A Shaik
- Department of Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida
| | - Michael Drucker
- Department of Cardiac Electrophysiology, Novant Health Cardiology of Forsyth Medical Center, Winston-Salem, North Carolina
| | - Christopher Pierce
- Department of Cardiac Electrophysiology, Sanford Medical Center, Fargo, North Dakota
| | - Gabor Z Duray
- Department of Cardiology, Medical Centre, Hungarian Defense Forces, Budapest, Hungary
| | - Shane Gillett
- Clinical Studies Department, Biotronik, Inc, Lake Oswego, Oregon
| | - Crystal Miller
- Clinical Studies Department, Biotronik, Inc, Lake Oswego, Oregon
| | - Camden Harrell
- Clinical Studies Department, Biotronik, Inc, Lake Oswego, Oregon
| | - George Thomas
- Division of Cardiology, Weill Cornell Medical College, New York, New York
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11
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Aleong RG, Zipse MM, Tompkins C, Aftab M, Varosy P, Sauer W, Kao D. Analysis of Outcomes in 8304 Patients Undergoing Lead Extraction for Infection. J Am Heart Assoc 2020; 9:e011473. [PMID: 32192410 PMCID: PMC7428595 DOI: 10.1161/jaha.118.011473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients undergoing lead extraction for infected devices have worse outcomes compared with those with noninfected devices. We assessed predictors of in-hospital mortality and procedure-related major adverse events (MAEs) in a large cohort undergoing lead extraction. Methods and Results Deidentified hospital records procedure from 7 states between 1994 and 2013 were aggregated and International Classification of Disease, Ninth Revision (ICD-9) procedure codes were used to identify hospital records reporting lead extraction. MAEs included death, cardiac tamponade, hemothorax, and need for emergent cardiac surgery. Predictors of in-hospital MAEs for infected compared with noninfected leads were identified using multivariate regression. Associations between outcomes and specific microbe were also assessed. In total, 57 220 discharges specified lead extraction. Infected leads accounted for the minority of total lead extractions compared with fractured leads (16.1 versus 59.8%, 25.7% not reported). There were 3298 MAEs (5.8%) including 980 deaths (1.7%). Multivariate predictors of MAE included black race, atrial fibrillation, anemia, heart failure, and admission via either hospital transfer or emergency department versus home (all P<0.001). Infected leads were associated with an increased risk of death (4.6% versus 0.9%, P<0.001) compared with leads with fracture only. Among patients with microbial data, staphylococcal infection was most common, whereas streptococcal infection was associated with the worst outcomes. Conclusions Patients undergoing extraction of infected leads have higher in-hospital mortality and adverse events compared with noninfected leads. Streptococcus, anemia, and heart failure are predictors of adverse outcomes.
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Affiliation(s)
- Ryan G Aleong
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Matthew M Zipse
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Christine Tompkins
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - Muhammad Aftab
- Department of Surgery Division of Cardiothoracic Surgery University of Colorado Denver CO
| | - Paul Varosy
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - William Sauer
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
| | - David Kao
- Section of Cardiac Electrophysiology University of Colorado Hospital Aurora CO
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12
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Barbar T, Patel R, Thomas G, Cheung JW. Strategies to Prevent Cardiac Implantable Electronic Device Infection. J Innov Card Rhythm Manag 2020; 11:3949-3956. [PMID: 32368364 PMCID: PMC7192142 DOI: 10.19102/icrm.2020.110102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
The association between the risk of mortality and cardiovascular implantable electronic device (CIED) infections has been well-established in the literature. As CIED implantations have increased in frequency in the past few decades, the incidence of CIED-related infections has also risen. Given the morbidity, mortality, and health-care costs associated with CIED infections, the prevention of device-related infection is a critical goal. Risk factors for developing CIED infections can be categorized as patient-, procedure-, or device-related. Numerous studies have highlighted different strategies for preventing CIED-related infections, which include patient optimization, device selection, and periprocedural preparation and treatment. Nonetheless, as the comorbidity burden of patients undergoing CIED implantation continues to increase, significant challenges in the successful elimination of CIED-related infections remain. This review provides a comprehensive overview of available evidence-based approaches and strategies to reduce the risk of CIED infections.
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Affiliation(s)
- Tarek Barbar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Rohan Patel
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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13
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Wong JA, Devereaux PJ. Cardiac Device Implantation Complications: A Gap in the Quality of Care? Ann Intern Med 2019; 171:368-369. [PMID: 31357214 DOI: 10.7326/m19-1895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jorge A Wong
- McMaster University, Hamilton, Ontario, Canada (J.A.W., P.D.)
| | - P J Devereaux
- McMaster University, Hamilton, Ontario, Canada (J.A.W., P.D.)
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14
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Ranasinghe I, Labrosciano C, Horton D, Ganesan A, Curtis JP, Krumholz HM, McGavigan A, Hossain S, Air T, Hariharaputhiran S. Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation: A Cohort Study. Ann Intern Med 2019; 171:309-317. [PMID: 31357210 DOI: 10.7326/m18-2810] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality. OBJECTIVE To assess institutional variation in risk-standardized complication rates (RSCRs) for CIED. DESIGN Cohort study. SETTING 174 hospitals in Australia and New Zealand, 98 of which implanted at least 25 CIEDs during the study period. PARTICIPANTS 81 304 patients older than 18 years (mean, 74.7 years [SD, 12.4]; 37.9% female) who received a new CIED (65 711 permanent pacemakers [PPMs] and 15 593 implantable cardioverter-defibrillators [ICDs]) in 2010 to 2015. MEASUREMENTS RSCRs and frequencies of major device-related complications during hospitalization or within 90 days of discharge. RESULTS Of the cohort, 6664 patients (8.2%) had a major complication. Although complication rates were higher for ICDs than PPMs (10.04% vs. 7.76%), 76.5% of all complications were attributable to PPMs (5098 vs. 1566 for ICDs). Among hospitals that implanted at least 25 CIEDs, the median RSCR was 8.1%; however, rates varied from 5.3% to 14.3%, with 22 hospitals identified as having RSCRs that differed significantly from the national average. Similar variation was observed when RSCRs for PPM implantation (n = 96 hospitals) (median RSCR, 7.6% [range, 5.4% to 12.9%]) were considered separately from those for ICD placement (n = 68 hospitals) (median RSCR, 9.7% [range, 6.2% to 16.9%]) and persisted when only elective procedures were assessed (n = 88 hospitals) (median RSCR, 7.4% [range, 4.7% to 13.0%]). LIMITATION Possible unmeasured confounding from the use of administrative data. CONCLUSION CIED complications are common and vary among hospitals, suggesting institutional variation in CIED care quality. Concerted clinical and policy interventions are needed to address CIED-related complications. These efforts should preferentially target PPMs, because most CIED complications are attributable to these devices. PRIMARY FUNDING SOURCE The Hospitals Contribution Fund Research Foundation.
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Affiliation(s)
- Isuru Ranasinghe
- Basil Hetzel Institute for Translational Research, University of Adelaide, and Central Adelaide Local Health Network, Adelaide, South Australia, Australia (I.R.)
| | | | - Dennis Horton
- Basil Hetzel Institute for Translational Research, University of Adelaide, and Data to Decisions Cooperative Research Centre, Adelaide, South Australia, Australia (D.H.)
| | - Anand Ganesan
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia (A.G., A.M.)
| | - Jeptha P Curtis
- Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut (J.P.C.)
| | - Harlan M Krumholz
- Yale-New Haven Hospital, Yale School of Medicine, and Yale University, New Haven, Connecticut (H.M.K.)
| | - Andrew McGavigan
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia (A.G., A.M.)
| | - Sadia Hossain
- Basil Hetzel Institute for Translational Research and University of Adelaide, Adelaide, South Australia, Australia (S.H., S.H.)
| | - Tracy Air
- University of Adelaide, Adelaide, South Australia, Australia (C.L., T.A.)
| | - Saranya Hariharaputhiran
- Basil Hetzel Institute for Translational Research and University of Adelaide, Adelaide, South Australia, Australia (S.H., S.H.)
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15
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Alvarez PA, Sperry BW, Pérez AL, Yaranov DM, Randhawa V, Luthman J, Cantillon DJ, Starling RC. Implantable Cardioverter Defibrillators in Patients With Continuous Flow Left Ventricular Assist Devices: Utilization Patterns, Related Procedures, and Complications. J Am Heart Assoc 2019; 8:e011813. [PMID: 31280637 PMCID: PMC6662142 DOI: 10.1161/jaha.118.011813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The effect of implantable cardioverter defibrillators (ICD) in patients with continuous flow left ventricular assist devices (LVADs) on outcomes has not been evaluated in a randomized clinical trial. Methods and Results This is a retrospective single‐center study that included patients who underwent continuous flow LVAD implantation at the Cleveland Clinic between October 2004 and March 2017. Patients were evaluated according to the presence or absence of ICD at the time of LVAD insertion. Among 486 patients in the study cohort, 387 (79.6%) had an ICD before LVAD insertion. Patients with ICD before LVAD were older and had lower use of pre‐LVAD inotropes, extracorporeal membrane oxygenation, and mechanical ventilation. There were 81 patients (21.4% of patients with ICD) who required 93 procedures after LVAD: 74 generator exchanges, 12 lead revisions, and 7 complete system removals because of infection. Of the 99 patients without ICD, 52 (53%) underwent ICD implantation: 29 for primary prevention and 23 for secondary prevention. Patients were followed for a median of 401 (interquartile range 150–966) days. The presence of a pre‐LVAD ICD was not associated with mortality in a multivariable model (hazard ratio 1.19, 95% CI 0.73–1.93, P=0.492), nor was the presence of an ICD at any point when analyzed as a time‐varying covariate (hazard ratio 1.05, 95% CI 0.50–2.20, P=0.907). Conclusions There is no apparent mortality benefit associated with an ICD in a contemporary cohort of patients with continuous flow LVADs to balance considerable morbidity involving ICD‐related procedures and complications.
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Affiliation(s)
- Paulino A Alvarez
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH.,2 Department of Cardiovascular Medicine University of Iowa Iowa City IA
| | - Brett W Sperry
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH.,3 Mid America Heart Institute Saint Luke's Hospital of Kansas City Kansas City MO
| | - Antonio L Pérez
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
| | - Dmitry M Yaranov
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
| | - Varinder Randhawa
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
| | - Jacob Luthman
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
| | - Daniel J Cantillon
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
| | - Randall C Starling
- 1 Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH
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16
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Frisch DR, Dikdan SJ. Clinical and Procedural Effects of Transitioning to Contact Force Guided Ablation for Atrial Fibrillation. J Atr Fibrillation 2019; 11:2081. [PMID: 31139294 DOI: 10.4022/jafib.2081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/17/2018] [Accepted: 11/25/2018] [Indexed: 11/10/2022]
Abstract
Background A major innovation in atrial fibrillation (AF) ablation has been the introduction of contact force (CF) sensing catheters. Objective To evaluate procedural and clinical effects of transitioning to CF-guided AF ablation. Methods Consecutive AF ablation patients were studiedduring the period of time of transitioning from a non-CF to CF sensing catheter. Procedural data recorded was total radiofrequency time, time to isolate the left pulmonary veins (LPVs), and time to isolate the right pulmonary veins (RPVs). Clinically, the 3 and 12-month maintenance of sinus rhythm was noted and compared by: paroxysmal vs. persistent AF; CT scan LA volume more or less than 150 cc; CHA2DS2VASC more or less than 2; and LVEF more or less than 55%. Safety data was recorded as well. Results Total ablation times were shorter (113 vs.146 min, p=0.011)when using the CF catheters compared to non-CF ablations. This was driven by a decrease in both LPV (46 vs.72 min, p<0.001) and RPV time (54 vs. 75 min, p=0.002).The use of CF catheter did not change the overall percentage of patients in sinus rhythm at 3 and 12-months of follow up. However, sinus rhythm was more frequent at 12 months with CF ablation inpatients with an LA volume of more than 150 cc when compared to non-CF ablation (84.6% and 52.4%, p=0.03). There was no difference in outcomes with stratification by CHA2DS2VASC score or LVEF. No significant difference in complications was noted. Conclusions For AF ablation, the initial use of CF-sensing technology reduced procedure times with similar overall sinus rhythm maintenance at 3 and 12 months. CF improved 12-month outcomes in patients with an enlarged LA.
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Affiliation(s)
- Daniel R Frisch
- Thomas Jefferson University Hospital, Division of Cardiology, 111 S 11th St, Philadelphia, PA 19107
| | - Sean J Dikdan
- Thomas Jefferson University Hospital, Division of Cardiology, 111 S 11th St, Philadelphia, PA 19107
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17
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Moen EL, Bynum JP, Skinner JS, O'Malley AJ. Physician network position and patient outcomes following implantable cardioverter defibrillator therapy. Health Serv Res 2019; 54:880-889. [PMID: 30937894 DOI: 10.1111/1475-6773.13151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes. DATA SOURCES Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011. STUDY DESIGN We constructed a national cardiovascular disease patient-sharing physician network and used network analysis to characterize physician network centrality with two measures: within-hospital degree centrality (number of connections within a hospital) and across-hospital degree centrality (number of connections across hospitals). The primary outcome was risk-adjusted 2-year case fatality. Hierarchical logistic regression estimated the effects of physician's within-hospital and across-hospital degree centrality on case fatality. We included 105 109 ICD therapy patients and 3474 ICD implanting physicians in our analyses. PRINCIPAL FINDINGS After controlling for other physician and hospital characteristics, we observed greater risk-adjusted case fatality among patients treated by physicians in the highest across-hospital degree tertile compared to lowest tertile (OR [95% CI] = 1.10 [1.04-1.16], P = 0.001) and lowest tertile volume physicians compared with highest volume (OR [95% CI] = 0.90 [0.84-0.95], P < 0.001). Physician's within-hospital degree tertile was inversely associated with case fatality but not statistically significant. CONCLUSIONS Degree centrality measures capture information independent of procedure volume and raise questions about the quality of physicians with networks that predict worse health outcomes.
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Affiliation(s)
- Erika L Moen
- Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julie P Bynum
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan S Skinner
- Department of Economics and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Alistair J O'Malley
- Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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18
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Refaat M, Zakka P, Khoury M, Chami H, Mansour S, Harbieh B, Abi-Saleh B, Bizri AR. Cardiac implantable electronic device infections: Observational data from a tertiary care center in Lebanon. Medicine (Baltimore) 2019; 98:e14906. [PMID: 31008922 PMCID: PMC6494368 DOI: 10.1097/md.0000000000014906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
With increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections. The most common microbial etiologies, including involvement in polymicrobial infection, were coagulase-negative staphylococci (45.5%) and Staphylococcus aureus (22.7%). Rare cases of Brucella melitensis, Sphingomonas paucimobilis, and Kytococcus schroeteri device infection were seen. Heart failure was seen in 77.3% of patients, hypertension in 68.2%, and chronic kidney disease in 50%. Skin changes were the most common presenting symptoms (86.4%). Antibiotics were given to all patients and all had their devices removed, with 36.4% undergoing new device implantation. This is the first study of CIED infections in Lebanon and the Middle East. Local epidemiology and occupational exposure must be considered while contemplating the microbial etiology of infection. Close monitoring after device implantation is important in preventing device infection that carries high risk of morbidity and mortality.
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Affiliation(s)
- Marwan Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Zakka
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Maurice Khoury
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan Chami
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Shareef Mansour
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bernard Harbieh
- Department of Internal Medicine, Division of Cardiology, Keserwan Medical Center
| | - Bernard Abi-Saleh
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Lebanon
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19
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Abstract
Cardiovascular implantable electronic devices (CIEDs) and the indications for their use have significantly risen over the past decades to include patients who are older with more medical comorbidities. Predictably, the rates of CIED infection have increased substantially. CIED infection is associated with high morbidity, mortality, and financial costs. This article discusses the appropriate management of CIED infections, which is imperative to limit the problems associated with infection.
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Affiliation(s)
- Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street Southwest, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, 200 1st Street Southwest, Rochester, MN, USA.
| | - Muhammad Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street Southwest, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, 200 1st Street Southwest, Rochester, MN, USA
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20
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Adegbala O, Olagoke O, Adejumo A, Akintoye E, Oluwole A, Alebna P, Williams K, Lieberman R, Afonso L. Incidence and outcomes of cardiac tamponade in patients undergoing cardiac resynchronization therapy. Int J Cardiol 2018; 272:137-141. [DOI: 10.1016/j.ijcard.2018.07.084] [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: 05/17/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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21
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Patel N, Viles-Gonzalez J, Agnihotri K, Arora S, Patel NJ, Aneja E, Shah M, Badheka AO, Pothineni NV, Kancharla K, Mulpuru S, Noseworthy PA, Kusumoto F, Cha YM, Deshmukh AJ. Frequency of in-hospital adverse outcomes and cost utilization associated with cardiac resynchronization therapy defibrillator implantation in the United States. J Cardiovasc Electrophysiol 2018; 29:1425-1435. [PMID: 30016005 DOI: 10.1111/jce.13701] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. METHODS AND RESULTS Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. CONCLUSIONS The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.
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Affiliation(s)
- Nilay Patel
- Internal Medicine Department, Saint Peter s University Hospital, New Brunswick, New Jersey
| | - Juan Viles-Gonzalez
- Cardiovascular Disease, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kanishk Agnihotri
- Internal Medicine Department, Saint Peter s University Hospital, New Brunswick, New Jersey
| | - Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St Luke's Roosevelt Hospital, New York, New York
| | - Nileshkumar J Patel
- Cardiovascular Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Ekta Aneja
- Internal Medicine Department, Saint Barnabas Medical Center, Bronx, New York
| | - Mahek Shah
- Cardiovascular Department, Lehigh Valley Healthcare Network, Allentown, Pennsylvania
| | - Apurva O Badheka
- Cardiovascular Department, The Everett Clinic, Everett, Washington
| | - Naga Venkata Pothineni
- Cardiovascular Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Krishna Kancharla
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Siva Mulpuru
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Peter A Noseworthy
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Fred Kusumoto
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Yong Mei Cha
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Abhishek J Deshmukh
- Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota
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22
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Özcan C, Raunsø J, Lamberts M, Køber L, Lindhardt TB, Bruun NE, Laursen ML, Torp-Pedersen C, Gislason GH, Hansen ML. Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study. Europace 2018; 19:1007-1014. [PMID: 28073883 DOI: 10.1093/europace/euw404] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
Aims To determine the incidence, risk factors, and mortality of infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED). Methods and results From Danish nationwide administrative registers (beginning in 1996), we identified all de-novo permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) together with the occurrence of post-implantation IE-events in the period from 2000-2012. Included were 43 048 first-time PM/ICD recipients. Total follow-up time was 168 343 person-years (PYs). The incidence rate (per 1000 PYs) of IE in PM was 2.1 (95% confidence interval [CI]: 1.7-2.6) for single chamber devices and 6.2 (95% CI: 4.5-8.7) for cardiac resynchronization therapy (CRT); similarly, the rate of IE in ICD was 3.7 (95% CI: 2.9-4.7) in single chamber devices and 6.3 (95% CI: 4.4-9.0) in CRT. In multivariable analysis, increased PM complexity served as independent risk factor for IE {dual chamber PM [hazard ratio (HR) 1.39; 95% CI: 1.07-1.80] and CRT [HR: 1.84; 95% CI: 1.20-2.84]}. During follow-up, generator replacement (HR: 2.79; 95% CI: 1.87-4.17) and lead revision (HR: 4.33; 95% CI: 3.25-5.78) in PMs were associated with increased risk. Corresponding estimates in ICDs were 2.49 (95% CI: 1.28-4.86) and 6.58 (95% CI: 4.49-9.63). Risk of death after IE was significantly increased in PM and ICD with HRs of 1.56 (95% CI: 1.33-1.82) and 2.63 (95% CI: 2.00-3.48), respectively. Conclusion The risk of IE increased with increasing PM complexity. Other important risk factors were subsequent generator replacement and lead revision. IE was associated with an increased risk of mortality in the area of CIED.
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Affiliation(s)
- Cengiz Özcan
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.,Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | - Tommi Bo Lindhardt
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.,Clinical Institute, Aalborg University, 9000 Aalborg, Denmark
| | | | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
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Guan G, Liu Z, Zhang Y, Wang F, Ji H, Li X, Chen Y, Yang X, Wei J, Yu K, Zhang M. Application of an Infection Control Protocol (ICP) Reduced Cardiac Device Infection (CDI) in Low-Volume Centers. Med Sci Monit 2018; 24:1366-1372. [PMID: 29508843 PMCID: PMC5851438 DOI: 10.12659/msm.909030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Cardiac device infection (CDI) is a serious complication of cardiovascular implantable electronic device (CIED) implantations. Many risk factors have been identified, but several are still uncertain. This study aimed to identify and evaluate the risk factors. Moreover, an infection control protocol (ICP) was carried out, and its efficacy in reducing CDIs was investigated. Material/Methods A total of 1259 patients who received permanent pacemaker (PPM) implantations were enrolled in this study in a 3-year period in a high-volume center and low-volume centers in the central area of Shaanxi Province, China. Follow-up data of all enrolled patients were collected. The risk factors for CDIs were identified and analyzed. The ICP was adopted in the low-volume centers. Data, including CDI rates, medical costs, and microbiology, were collected and compared. Results Male gender, diabetes, CKD, operation duration, PPM replacement, and low center volume were identified as the risk factors for CDIs. Furthermore, CDI rates in low-volume centers were significantly higher than in high-volume centers. The adoption of an ICP dramatically reduced CDI rates in low-volume centers without significant increases in medical costs. Conclusions ICPs were easily carried out, effective, and economical in controlling CDIs in low-volume centers, which was identified as a risk factor of CDIs.
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Affiliation(s)
- Gongchang Guan
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Zhongwei Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland).,Institute of Molecular Genetics, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yong Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Fangyun Wang
- Department of Interventional Radiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Haiming Ji
- Department of Interventional Radiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Xuewen Li
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Yuan Chen
- Department of Cardiology, Xi'an Dianli Central Hospital, Xi'an, Shaanxi, China (mainland)
| | - Xiaoqiang Yang
- Department of Cardiology, Shaanxi Yangling Demonstration Zone Hospital, Xi'an, Shaanxi, China (mainland)
| | - Jianxia Wei
- Department of Cardiology, Shaanxi Friendship Hospital, Xi'an, Shaanxi, China (mainland)
| | - Kai Yu
- Department of Cardiology, Shaanxi Pucheng People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Ming Zhang
- Department of Cardiology, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China (mainland)
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Tracy CM, Crossley GH, Bunch TJ, Chow GV, Leiserowitz A, Indik JH, Kusumoto F, Mendes LA, Munger TM, Murali S, Patton KK, Russo AM, Scheinman M, Schoenhard JA, Winterfield JR. 2017 ACC/HRS lifelong learning statement for clinical cardiac electrophysiology specialists. Heart Rhythm 2018; 15:e17-e34. [DOI: 10.1016/j.hrthm.2017.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 11/29/2022]
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25
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Tracy CM, Crossley GH, Bunch TJ, Chow GV, Leiserowitz A, Indik JH, Kusumoto F, Mendes LA, Munger TM, Murali S, Patton KK, Russo AM, Scheinman M, Schoenhard JA, Winterfield JR. 2017 ACC/HRS Lifelong Learning Statement for Clinical Cardiac Electrophysiology Specialists. J Am Coll Cardiol 2018; 71:231-250. [DOI: 10.1016/j.jacc.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Ross JS, Bates J, Parzynski CS, Akar JG, Curtis JP, Desai NR, Freeman JV, Gamble GM, Kuntz R, Li SX, Marinac-Dabic D, Masoudi FA, Normand SLT, Ranasinghe I, Shaw RE, Krumholz HM. Can machine learning complement traditional medical device surveillance? A case study of dual-chamber implantable cardioverter-defibrillators. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:165-188. [PMID: 28860874 PMCID: PMC5566316 DOI: 10.2147/mder.s138158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Machine learning methods may complement traditional analytic methods for medical device surveillance. METHODS AND RESULTS Using data from the National Cardiovascular Data Registry for implantable cardioverter-defibrillators (ICDs) linked to Medicare administrative claims for longitudinal follow-up, we applied three statistical approaches to safety-signal detection for commonly used dual-chamber ICDs that used two propensity score (PS) models: one specified by subject-matter experts (PS-SME), and the other one by machine learning-based selection (PS-ML). The first approach used PS-SME and cumulative incidence (time-to-event), the second approach used PS-SME and cumulative risk (Data Extraction and Longitudinal Trend Analysis [DELTA]), and the third approach used PS-ML and cumulative risk (embedded feature selection). Safety-signal surveillance was conducted for eleven dual-chamber ICD models implanted at least 2,000 times over 3 years. Between 2006 and 2010, there were 71,948 Medicare fee-for-service beneficiaries who received dual-chamber ICDs. Cumulative device-specific unadjusted 3-year event rates varied for three surveyed safety signals: death from any cause, 12.8%-20.9%; nonfatal ICD-related adverse events, 19.3%-26.3%; and death from any cause or nonfatal ICD-related adverse event, 27.1%-37.6%. Agreement among safety signals detected/not detected between the time-to-event and DELTA approaches was 90.9% (360 of 396, k=0.068), between the time-to-event and embedded feature-selection approaches was 91.7% (363 of 396, k=-0.028), and between the DELTA and embedded feature selection approaches was 88.1% (349 of 396, k=-0.042). CONCLUSION Three statistical approaches, including one machine learning method, identified important safety signals, but without exact agreement. Ensemble methods may be needed to detect all safety signals for further evaluation during medical device surveillance.
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Affiliation(s)
- Joseph S Ross
- Section of General Medicine, Department of Medicine
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine
- Department of Health Policy and Management, Yale School of Public Health
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
| | - Jonathan Bates
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
| | - Craig S Parzynski
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
| | - Joseph G Akar
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - James V Freeman
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Ginger M Gamble
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
| | | | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
| | - Danica Marinac-Dabic
- Division of Epidemiology, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Isuru Ranasinghe
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Richard E Shaw
- Department of Clinical Informatics, California Pacific Medical Center, San Francisco, CA, USA
| | - Harlan M Krumholz
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine
- Department of Health Policy and Management, Yale School of Public Health
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
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Abstract
Advances in the field of defibrillation have brought to practice different types of devices that include the transvenous implantable cardioverter-defibrillator (ICD) with or without cardiac resynchronization therapy, the subcutaneous ICD (S-ICD), and the wearable cardioverter-defibrillator. To ensure optimal use of these devices and to achieve best patient outcomes, clinicians need to understand how these devices work, learn the characteristics of patients who qualify them for one type of device versus another, and recognize the remaining gaps in knowledge surrounding these devices. The transvenous ICD has been shown in several randomized clinical trials to improve the survival of patients resuscitated from near-fatal ventricular fibrillation and those with sustained ventricular tachycardia with syncope or systolic heart failure as a result of ischemic or nonischemic cardiomyopathy despite receiving guideline-directed medical therapy. Important gaps in knowledge regarding the transvenous ICD involve the role of the ICD in patient subgroups not included, or not well represented, in clinical trials and the need to refine the selection criteria for the ICD in patients who are indicated for it. S-ICDs were recently introduced into the clinical arena as another option for many patients who have an approved indication for a transvenous ICD. The main advantage of the S-ICD is a lower risk of infection and lead-related complications; however, the S-ICD does not offer bradycardia or antitachycardia pacing. The S-ICD may be ideal for patients with limited vascular access, high infection risk, or some congenital heart diseases. However, more data are needed regarding the efficacy and effectiveness of the S-ICD in comparison to transvenous ICDs, the extent of defibrillation testing required, and the use of the S-ICD with other novel technologies, including leadless pacemakers. Cardiac resynchronization therapy-defibrillators are indicated in patients with a left ventricular ejection fraction ≤35%, QRS width ≥130 ms, and New York Heart Association class II, III, or ambulatory IV symptoms despite treatment with guideline-directed medical therapy. Multiple randomized controlled trials have shown that the cardiac resynchronization therapy-defibrillator improves survival, quality of life, and several echocardiographic measures. One main challenge related to cardiac resynchronization therapy-defibrillators is the 30% nonresponse rate. Many initiatives are underway to address this challenge including improved cardiac resynchronization therapy and imaging technologies and enhanced selection of patients and device programming.
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Affiliation(s)
- Sana M Al-Khatib
- From the Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.).
| | - Paul Friedman
- From the Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Kenneth A Ellenbogen
- From the Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
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28
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Knops RE, Brouwer TF. ¿El desfibrilador subcutáneo debería ser la primera elección en la prevención primaria de la muerte súbita? Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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29
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Eldabe S, Buchser E, Duarte RV. Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature. PAIN MEDICINE 2017; 17:325-36. [PMID: 26814260 DOI: 10.1093/pm/pnv025] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Spinal cord and peripheral neurostimulation techniques have been practiced since 1967 for the relief of pain, and some techniques are also used for improvement in organ function. Neuromodulation has recognized complications, although very rarely do these cause long-term morbidity. The aim of this article is to present a review of complications observed in patients treated with neurostimulation techniques. METHODS A review of the major recent publications in the literature on the subjects of spinal cord, occipital, sacral, and peripheral nerve field stimulation was conducted. RESULTS The incidence of complications reported varies from 30% to 40% of patients affected by one or more complications. Adverse events can be subdivided into hardware-related complications and biological complications. The commonest hardware-related complication is lead migration. Other lead related complications such as failure or fracture have also been reported. Common biological complications include infection and pain over the implant. Serious biological complications such as dural puncture headache and neurological damage are rarely observed. CONCLUSIONS Spinal cord and peripheral neurostimulation techniques are safe and reversible therapies. Hardware-related complications are more commonly observed than biological complications. Serious adverse events such as neurological damage are rare.
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30
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Trends in Cardiac Tamponade Among Recipients of Permanent Pacemakers in the United States: From 2008 to 2012. JACC Clin Electrophysiol 2017; 3:41-46. [DOI: 10.1016/j.jacep.2016.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/19/2016] [Accepted: 05/26/2016] [Indexed: 12/21/2022]
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31
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Knops RE, Brouwer TF. Should the Subcutaneous Implantable Defibrillator Be the First Choice for Primary Prevention of Sudden Cardiac Death? ACTA ACUST UNITED AC 2016; 70:142-144. [PMID: 27838348 DOI: 10.1016/j.rec.2016.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom F Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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32
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Kurita T. Cardiac electrical device-related bacterial infections: Prevention, diagnosis, and management. J Arrhythm 2016; 32:245-6. [PMID: 27588147 PMCID: PMC4996898 DOI: 10.1016/j.joa.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Takashi Kurita
- Division of Cardiovascular Center, Kindai University, School of Medicine, Japan
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33
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Cardiac implantable electronic device infection due to Mycobacterium species: a case report and review of the literature. BMC Res Notes 2016; 9:414. [PMID: 27553460 PMCID: PMC4995631 DOI: 10.1186/s13104-016-2221-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Infection of cardiac implantable electronic devices is a serious cardiovascular disease and it is associated with a high mortality. Mycobacterium species may rarely cause cardiac implantable electronic devices infection. CASE PRESENTATION We are reporting a case of miliary tuberculosis in an Arab patient with dilated cardiomyopathy and a cardiac resynchronization therapy-defibrillator device that was complicated with infection of his cardiac resynchronization therapy-defibrillator device. To our knowledge, this is the third case in the literature with such a presentation and all patients died during the course of treatment. This underscores the importance of early diagnosis and management. We also performed a literature review of reported cases of cardiac implantable electronic devices infection related to Mycobacterium species. CONCLUSIONS Cardiac implantable electronic devices infection due to Mycobacterium species is an uncommon but a well-known entity. Early diagnosis and prompt management may result in a better outcome.
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34
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Benetti MA, Nunes RAB, Benvenuti LA. Case 2/2016 - 76-Year-Old Male with Hypertensive Heart Disease, Renal Tumor and Shock. Arq Bras Cardiol 2016; 106:439-46. [PMID: 27305288 PMCID: PMC4914010 DOI: 10.5935/abc.20160067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Timmers L, Van Heuverswyn F, De Wilde H, Jordaens L. Evaluating current implantable cardioverter defibrillator implantation procedures: can common complications be minimised? Expert Rev Cardiovasc Ther 2016; 14:579-89. [DOI: 10.1586/14779072.2016.1144471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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Rahman S, Oesterle AC, Badhwar N. A Subclavian Arteriovenous Fistula Associated with Implantable Cardioverter-Defibrillator Implantation. Card Electrophysiol Clin 2016; 8:185-9. [PMID: 26920192 DOI: 10.1016/j.ccep.2015.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Subclavian arteriovenous fistulas (AVFs) should be considered in the differential diagnosis of a patient presenting with worsening CHF symptoms or unilateral edema immediately after device implantation. A palpable thrill may be present or a bruit may be auscultated in the region of the fistula. Ultrasonography has limitations in the subclavian region and definitive diagnosis is only made by angiogram. Percutaneous occlusion of the AVF is preferred as surgical repair is associated with significant morbidity and mortality.
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Affiliation(s)
- Salman Rahman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU East 431, Box 1354, San Francisco, CA 94143, USA
| | - Adam C Oesterle
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU East 431, Box 1354, San Francisco, CA 94143, USA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU East 431, Box 1354, San Francisco, CA 94143, USA.
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37
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Atreya AR, Cook JR, Lindenauer PK. Complications arising from cardiac implantable electrophysiological devices: review of epidemiology, pathogenesis and prevention for the clinician. Postgrad Med 2016; 128:223-30. [DOI: 10.1080/00325481.2016.1151327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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38
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Zipes DP, Calkins H, Daubert JP, Ellenbogen KA, Field ME, Fisher JD, Fogel RI, Frankel DS, Gupta A, Indik JH, Kusumoto FM, Lindsay BD, Marine JE, Mehta LS, Mendes LA, Miller JM, Munger TM, Sauer WH, Shen WK, Stevenson WG, Su WW, Tracy CM, Tsiperfal A. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Heart Rhythm 2016; 13:e3-e37. [DOI: 10.1016/j.hrthm.2015.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Indexed: 12/20/2022]
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39
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Ascoeta MS, Marijon E, Defaye P, Klug D, Beganton F, Perier MC, Gras D, Algalarrondo V, Deharo JC, Leclercq C, Fauchier L, Babuty D, Bordachar P, Sadoul N, Boveda S, Piot O. Impact of early complications on outcomes in patients with implantable cardioverter-defibrillator for primary prevention. Heart Rhythm 2016; 13:1045-1051. [PMID: 26749313 DOI: 10.1016/j.hrthm.2015.12.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The lifesaving benefit of implantable cardioverter-defibrillators (ICDs) has been demonstrated. Their use has increased considerably in the past decade, but related complications have become a major concern. OBJECTIVE The purpose of this study was to assess the incidence and effect on outcomes of early (≤30 days) complications after ICD implantation for primary prevention in a large French population. METHODS We analyzed data from 5539 patients from the multicenter French DAI-PP (Défibrillateur Automatique Implantable-Prévention Primaire) registry (2002-2012) who had coronary artery disease or dilated cardiomyopathy and were implanted with an ICD for primary prevention. RESULTS Overall, early complications occurred in 707 patients (13.5%), mainly related to lead dislodgment or hematoma (57%). Independent factors associated with occurrence of early complications were severe renal impairment (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.17-2.37, P = .02), age ≥75 years (OR 1.01, 95% CI 1.00-1.02, P = .03), cardiac resynchronization therapy (OR 1.58, 95% CI 1.16-2.17, P = .01), and anticoagulant therapy (OR 1.28, 95% CI 1.02-1.61, P = .03). During a mean ± SD follow-up of 3.1 ± 2.3 years, 824 (15.8%) patients experienced ≥1 late complication (>30 days), and 782 (14.9%) patients died. After adjustment, early complications remained associated with occurrence of late complications (OR 2.15, 95% CI 1.73-2.66, P < .0001) and mortality (OR 1.70, 95% CI 1.34-2.17, P = .003). CONCLUSION Early complications are common after ICD implantation for primary prevention, occurring in 1 in 7 patients, and are associated with an increased risk of late complications and overall mortality. Further studies are needed to investigate the underlying mechanisms of such associations.
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Affiliation(s)
| | - Eloi Marijon
- European Georges Pompidou Hospital and Paris Descartes University, Paris, France
| | | | | | - Frankie Beganton
- Paris Cardiovascular Research Center, Inserm U(††#), Paris, France
| | | | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | | | | | | | | | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France.
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- European Georges Pompidou Hospital and Paris Descartes University, Paris, France
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40
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Kirkfeldt RE, Johansen JB, Nielsen JC. Management of Cardiac Electronic Device Infections: Challenges and Outcomes. Arrhythm Electrophysiol Rev 2016; 5:183-187. [PMID: 28116083 DOI: 10.15420/aer.2016:21:2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in 'higher risk' candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials.
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41
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2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). J Am Coll Cardiol 2015; 66:2767-2802. [DOI: 10.1016/j.jacc.2015.08.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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42
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Nakajima H, Taki M. Incidence of cardiac implantable electronic device infections and migrations in Japan: Results from a 129 institute survey. J Arrhythm 2015; 32:303-7. [PMID: 27588154 PMCID: PMC4996866 DOI: 10.1016/j.joa.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/06/2015] [Accepted: 09/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We conducted a survey of the infection burden associated with the implantation of cardiac implantable electronic devices (CIEDs) in Japan. METHODS The institutes were selected using annual device implantation data provided by Medtronic Japan Co., Ltd. The data sampling period was from January 1 to December 31, 2013. Institutes were classified into Group P, at which only pacemakers were implanted, and Group A, at which other CIEDs were implanted. Group P was further classified into three sub-groups by implantation number. The infection rate was compared between groups using logistic regression analysis. RESULTS A total of 129 of 138 institutes responded. The annual infection rate was 1.12% for overall CIEDs. The institute at which 15-29 pacemakers were implanted had a high infection rate (2.11%). No statistically significant difference was observed (adjusted p=0.1131). The overall migration rate was 0.50%. Complete removal of the CIED system was performed in 55.8% of patients who underwent implantation. CONCLUSIONS This survey was the first on CIED infection and migration in Japan. The CIED infection rate (1.12%) was similar to that previously reported. A high infection rate (2.77%) was observed in the infection experienced institutes.
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Affiliation(s)
- Hiroshi Nakajima
- Japan Research Institute for Device Therapy, NT Bldg., 1-1-12, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan
| | - Masami Taki
- Medtronic Japan Co., Ltd., 2-14-1 Higashi Shimbashi, Minato-ku, Tokyo 105-0021 Japan
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44
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Provenzano DA, Deer T, Luginbuhl Phelps A, Drennen ZC, Thomson S, Hayek SM, Narouze S, Rana MV, Watson TW, Buvanendran A. An International Survey to Understand Infection Control Practices for Spinal Cord Stimulation. Neuromodulation 2015; 19:71-84. [DOI: 10.1111/ner.12356] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/08/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Timothy Deer
- The Center for Pain Relief, Inc.; Charleston WV USA
| | - Amy Luginbuhl Phelps
- Economic and Finance Department at the AJ Palumbo Donahue School of Business; Duquesne University; Pittsburgh PA USA
| | | | - Simon Thomson
- Basildon and Thurrock University Hospitals; Grays Essex UK
| | - Salim M. Hayek
- University Hospitals Case Medical Center; Cleveland OH USA
| | - Samer Narouze
- Center for Pain Medicine at Western Reserve Hospital; Cuyahoga Falls OH USA
| | - Maunak V. Rana
- Advocate Illinois Masonic Medical Center; Chicago IL USA
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ARYANA ARASH, BOWERS MARKR, GEAROID O'NEILL PADRAIG, SINGH SHELDONM. Use of Antimicrobial Envelope as Standard of Care for Cardiac Implantable Electronic Device Implantation: Preventing Infection or Promoting Inflation? J Cardiovasc Electrophysiol 2015; 26:E12. [DOI: 10.1111/jce.12728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- ARASH ARYANA
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute; Sacramento California USA
| | - MARK R. BOWERS
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute; Sacramento California USA
| | - PADRAIG GEAROID O'NEILL
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute; Sacramento California USA
| | - SHELDON M. SINGH
- Sunnybrook Health Sciences Centre; University of Toronto; Ontario Canada
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Zipes DP, Calkins H, Daubert JP, Ellenbogen KA, Field ME, Fisher JD, Fogel RI, Frankel DS, Gupta A, Indik JH, Kusumoto FM, Lindsay BD, Marine JE, Mehta LS, Mendes LA, Miller JM, Munger TM, Sauer WH, Shen WK, Stevenson WG, Su WW, Tracy CM, Tsiperfal A, Williams ES, Halperin JL, Arrighi JA, Awtry EH, Bates ER, Brush JE, Costa S, Daniels L, Desai A, Drachman DE, Fernandes S, Freeman R, Ijioma N, Khan SS, Kuvin JT, Marine JE, McPherson JA, Mendes LA, Sivaram CA, Spicer RL, Wang A, Weitz HH. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Circ Arrhythm Electrophysiol 2015; 8:1522-51. [PMID: 26386016 DOI: 10.1161/hae.0000000000000014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications. Heart Rhythm 2015; 13:443-54. [PMID: 26385533 DOI: 10.1016/j.hrthm.2015.09.010] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are implanted with the intention to prolong life in selected patients with inherited arrhythmia syndromes, but ICD implantation is also associated with inappropriate shocks and complications. OBJECTIVE We aimed to quantify the rate of inappropriate shocks and other ICD-related complications to be able to weigh benefit and harm in these patients. METHODS We performed a systematic review and meta-analysis of inappropriate shock and/or other ICD-related complication rates, including ICD-related mortality, in patients with inherited arrhythmia syndromes, that is, arrhythmogenic right ventricular cardiomyopathy/dysplasia, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, dilated cardiomyopathy due to a mutation in the lamin A/C gene, long QT syndrome, and short QT syndrome. We searched MEDLINE and EMBASE from inception to May 30, 2014. RESULTS Of 2471 unique citations, 63 studies comprising 4916 patients with inherited arrhythmia syndromes (mean age of 39 ± 15 years) were included. Inappropriate shocks occurred in 20% of patients (crude annual rate of 4.7% per year), with a significantly higher rate in studies published before 2008 (6.1% per year vs 4.1% per year). Moreover, 22% experienced ICD-related complications (4.4% per year) and there was a 0.5% ICD-related mortality (0.08% per year). CONCLUSION ICD implantation carries a significant risk of inappropriate shocks and inhospital and postdischarge complications in relatively young patients with inherited arrhythmia syndromes. These data can be used to better inform patients and physicians about the expected risk of adverse ICD events and thereby facilitate shared decision making.
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Knops RE, Brouwer TF, Barr CS, Theuns DA, Boersma L, Weiss R, Neuzil P, Scholten M, Lambiase PD, Leon AR, Hood M, Jones PW, Wold N, Grace AA, Olde Nordkamp LRA, Burke MC. The learning curve associated with the introduction of the subcutaneous implantable defibrillator. Europace 2015; 18:1010-5. [PMID: 26324840 PMCID: PMC4927061 DOI: 10.1093/europace/euv299] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 02/02/2023] Open
Abstract
Aims The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters with respect to implant-related complications, procedure time, and inappropriate shocks (IASs). Methods and results In a pooled cohort from two clinical S-ICD databases, the IDE Trial and the EFFORTLESS Registry, complications, IASs at 180 days follow-up and implant procedure duration were assessed. Patients were grouped in quartiles based on experience of the implanter and Kaplan–Meier estimates of complication and IAS rates were calculated. A total of 882 patients implanted in 61 centres by 107 implanters with a median of 4 implants (IQR 1,8) were analysed. There were a total of 59 patients with complications and 48 patients with IAS. The complication rate decreased significantly from 9.8% in Quartile 1 (least experience) to 5.4% in Quartile 4 (most experience) (P = 0.02) and non-significantly for IAS from 7.9 to 4.8% (P = 0.10). Multivariable analysis demonstrated a hazard ratio of 0.78 (P = 0.045) for complications and 1.01 (P = 0.958) for IAS. Dual-zone programming increased with experience of the individual implanter (P < 0.001), which reduced IAS significantly in the multivariable model (HR 0.44, P = 0.01). Procedure time decreased from 75 to 65 min (P < 0.001). The complication rate and procedure time stabilized after Quartile 2 (>13 implants). Conclusion There is a short and significant learning curve associated with physicians adopting the S-ICD. Performance stabilizes after 13 implants.
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Affiliation(s)
| | | | | | | | | | - Raul Weiss
- Ohio State University, Columbus, OH, USA
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3126] [Impact Index Per Article: 347.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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Yu TH, Tung YC, Chung KP. Does Categorization Method Matter in Exploring Volume-Outcome Relation? A Multiple Categorization Methods Comparison in Coronary Artery Bypass Graft Surgery Surgical Site Infection. Surg Infect (Larchmt) 2015; 16:466-72. [PMID: 26069929 DOI: 10.1089/sur.2014.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Volume-infection relation studies have been published for high-risk surgical procedures, although the conclusions remain controversial. Inconsistent results may be caused by inconsistent categorization methods, the definitions of service volume, and different statistical approaches. The purpose of this study was to examine whether a relation exists between provider volume and coronary artery bypass graft (CABG) surgical site infection (SSI) using different categorization methods. METHODS A population-based cross-sectional multi-level study was conducted. A total of 10,405 patients who received CABG surgery between 2006 and 2008 in Taiwan were recruited. The outcome of interest was surgical site infection for CABG surgery. The associations among several patient, surgeon, and hospital characteristics was examined. The definition of surgeons' and hospitals' service volume was the cumulative CABG service volumes in the previous year for each CABG operation and categorized by three types of approaches: Continuous, quartile, and k-means clustering. RESULTS The results of multi-level mixed effects modeling showed that hospital volume had no association with SSI. Although the relation between surgeon volume and surgical site infection was negative, it was inconsistent among the different categorization methods. CONCLUSIONS Categorization of service volume is an important issue in volume-infection study. The findings of the current study suggest that different categorization methods might influence the relation between volume and SSI. The selection of an optimal cutoff point should be taken into account for future research.
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Affiliation(s)
- Tsung-Hsien Yu
- Institute of Health Policy and Management, National Taiwan University , Taipei, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, National Taiwan University , Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, National Taiwan University , Taipei, Taiwan
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