1
|
Zaky A, Melvin RL, Benz D, Davies J, Panayotis V, Maddox W, Shah R, Lynch T, Beck A, Hearld K, McElderry T, Treggiari M. Economic Evaluation of Anesthesiology-Led Cardiac Implantable Electronic Device Service. Healthcare (Basel) 2023; 11:1864. [PMID: 37444698 DOI: 10.3390/healthcare11131864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Implementation of an anesthesiology-led cardiac implantable electronic device (CIED) service can be viewed to have economic and efficiency challenges. This study evaluates the cost savings of an anesthesiology-led CIED service. METHODS A total of 830 patients presented in the pre-implementation period from 1 March 2016 to 31 December 2017, and 1981 patients presented in the post-implementation period from 1 January 2018 to 31 October 2021. Interrupted time-series analysis for single-group comparisons was used to evaluate the cost savings resulting from reduction in operating room (OR) start delays for patients with CIEDs. RESULTS OR start-time delay was reduced by 10.6 min (95%CI: -20.5 to -0.83), comparing pre- to post-implementation. For an OR cost of USD 45/min, we estimated the direct cost to the department to be USD 1.68/min. The intervention translated into a total cost reduction during the intervention period of USD 250,000 (USD 18,000 to USD 470,000) per year for the institution and USD 9800 (USD 730 to USD 17,000) per year for the department. The yearly cost of employing a full-time team of CIED specialists would have been USD 135,456. The service triggered electrophysiology consultation on 13 device malfunctions. CONCLUSIONS An anesthesiology-led CIED service resulted in substantial cost savings, increased OR efficiency and patient safety.
Collapse
Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - Ryan L Melvin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - David Benz
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - James Davies
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - Vardas Panayotis
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - William Maddox
- Department of Cardiology, Division of Electrophysiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Ruchit Shah
- Department of Cardiology, Division of Electrophysiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Tom Lynch
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - Adam Beck
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Kristine Hearld
- School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Tom McElderry
- Department of Cardiology, Division of Electrophysiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Miriam Treggiari
- Department of Anesthesiology and Perioperative Medicine, Duke University, Durham, NC 27708, USA
| |
Collapse
|
2
|
Cronin B, Dalia A, Goh R, Essandoh M, Orestes O'Brien E. Temporary Epicardial Pacing After Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:4427-4439. [PMID: 36180288 DOI: 10.1053/j.jvca.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Temporary epicardial pacing frequently is employed after cardiac surgery, and can have a significant impact on a patient's hemodynamics, arrhythmias, and valvulopathies. Given that anesthesiologists often are involved intimately in the initial programming and subsequent management of epicardial pacing in the operating room and intensive care unit, it is important for practitioners to have a detailed understanding of the modes, modifiable intervals, and potential complications that can occur after cardiac surgery. Because this topic has not been reviewed recently in anesthesia literature, the authors attempted to review relevant epicardial pacemaker specifics, discuss modes and parameters that apply to the perioperative period, present an algorithm for mode selection, describe the potential effects of epicardial pacing on valvulopathies and hemodynamics, and, finally, discuss some postoperative considerations.
Collapse
Affiliation(s)
- Brett Cronin
- Department of Anesthesiology, University of California-San Diego Medical Center, San Diego, CA.
| | - Adam Dalia
- Division of Cardiac Anesthesiology, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital (of Harvard Medical School), Boston, MA
| | - Regine Goh
- Department of Anesthesiology, University of California-San Diego Medical Center, San Diego, CA
| | - Michael Essandoh
- Cardiovascular Anesthesiology, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - E Orestes O'Brien
- Department of Anesthesiology, University of California-San Diego Medical Center, San Diego, CA
| |
Collapse
|
3
|
AlRahabi MK, Ghabbani HM. Influence and safety of electronic apex locators in patients with cardiovascular implantable electronic devices: a systematic review. Libyan J Med 2019; 14:1547071. [PMID: 30458679 PMCID: PMC6249593 DOI: 10.1080/19932820.2018.1547071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
The widespread use of cardiovascular implantable electronic devices has increased concerns regarding using electronic apex locators in patients with these devices. This systematic review investigated the effects and safety of using electronic apex locators in patients with cardiovascular implantable electronic devices. METHODS An electronic search in the Cochrane Library, PubMed (MEDLINE), ScienceDirect, and Scientific Electronic Library Online (Scielo) databases for relevant articles published between December 2000 and December 2018 was performed. The search strategy centered on terms related to electronic apex locators use during root canal treatment in patients with cardiovascular implantable electronic devices. RESULTS Seven studies (five in vitro and two in vivo) fulfilled the inclusion criteria for this review. It was found that electronic apex locators can be used safely in patients with cardiovascular implantable electronic devices, when general precautions are followed. CONCLUSIONS Although the present review suggests that electronic apex locators can be used safely in patients with implantable cardioverter defibrillators, consultation with patients' cardiologists remains advisable.
Collapse
Affiliation(s)
| | - Hani M. Ghabbani
- College of Dentistry, Taibah University, Madinah Al Munawwarah, Saudi Arabia
| |
Collapse
|
4
|
Schulman PM, Treggiari MM, Yanez ND, Henrikson CA, Jessel PM, Dewland TA, Merkel MJ, Sera V, Harukuni I, Anderson RB, Kahl E, Bingham A, Alkayed N, Stecker EC. Electromagnetic Interference with Protocolized Electrosurgery Dispersive Electrode Positioning in Patients with Implantable Cardioverter Defibrillators. Anesthesiology 2019; 130:530-540. [DOI: 10.1097/aln.0000000000002571] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
The goal of this study was to determine the occurrence of intraoperative electromagnetic interference from monopolar electrosurgery in patients with an implantable cardioverter defibrillator undergoing surgery. A protocolized approach was used to position the dispersive electrode.
Methods
This was a prospective cohort study including 144 patients with implantable cardioverter defibrillators undergoing surgery between May 2012 and September 2016 at an academic medical center. The primary objectives were to determine the occurrences of electromagnetic interference and clinically meaningful electromagnetic interference (interference that would have resulted in delivery of inappropriate antitachycardia therapy had the antitachycardia therapy not been programmed off) in noncardiac surgeries above the umbilicus, noncardiac surgeries at or below the umbilicus, and cardiac surgeries with the use of an underbody dispersive electrode.
Results
The risks of electromagnetic interference and clinically meaningful electromagnetic interference were 14 of 70 (20%) and 5 of 70 (7%) in above-the-umbilicus surgery, 1 of 40 (2.5%) and 0 of 40 (0%) in below-the-umbilicus surgery, and 23 of 34 (68%) and 10 of 34 (29%) in cardiac surgery. Had conservative programming strategies intended to reduce the risk of inappropriate antitachycardia therapy been employed, the occurrence of clinically meaningful electromagnetic interference would have been 2 of 70 (2.9%) in above-the-umbilicus surgery and 3 of 34 (8.8%) in cardiac surgery.
Conclusions
Despite protocolized dispersive electrode positioning, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with surgery above the umbilicus were high, supporting published recommendations to suspend antitachycardia therapy whenever monopolar electrosurgery is used above the umbilicus. For surgery below the umbilicus, these risks were negligible, implying that suspending antitachycardia therapy is likely unnecessary in these patients. For cardiac surgery, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with an underbody dispersive electrode were high. Conservative programming strategies would not have eliminated the risk of clinically meaningful electromagnetic interference in either noncardiac surgery above the umbilicus or cardiac surgery.
Collapse
Affiliation(s)
- Peter M. Schulman
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Miriam M. Treggiari
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - N. David Yanez
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Charles A. Henrikson
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Peter M. Jessel
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Thomas A. Dewland
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Matthias J. Merkel
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Valerie Sera
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Izumi Harukuni
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ryan B. Anderson
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ed Kahl
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ann Bingham
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Nabil Alkayed
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Eric C. Stecker
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| |
Collapse
|
5
|
Cronin B, Essandoh MK. Update on Cardiovascular Implantable Electronic Devices for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:1871-1884. [DOI: 10.1053/j.jvca.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/11/2022]
|
6
|
Cronin B, Essandoh MK. Perioperative Interrogation of St. Jude Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:982-1000. [DOI: 10.1053/j.jvca.2017.11.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/11/2022]
|
7
|
Ellis MKM, Treggiari MM, Robertson JM, Rozner MA, Graven PF, Aziz MF, Merkel MJ, Kahl EA, Cohen NA, Stecker EC, Schulman PM. Process Improvement Initiative for the Perioperative Management of Patients With a Cardiovascular Implantable Electronic Device. Anesth Analg 2017; 125:58-65. [DOI: 10.1213/ane.0000000000001953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
8
|
Gerstein NS, McLean AR, Stecker EC, Schulman PM. External Defibrillator Damage Associated With Attempted Synchronized Dual-Dose Cardioversion. Ann Emerg Med 2017; 71:109-112. [PMID: 28559035 DOI: 10.1016/j.annemergmed.2017.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/25/2022]
Abstract
The simultaneous use of 2 external defibrillators to administer either dual or sequential cardioversion or defibrillation for refractory cardiac arrhythmias is increasing in both the out-of-hospital and inhospital settings. Using 2 defibrillators to administer higher energy levels than can be achieved with a single defibrillator is considered off-label and is currently not part of published advanced cardiac life support guidelines. We report the first case in which the use of dual-dose cardioversion was associated with external defibrillator damage. Because defibrillator damage, especially if undetected, jeopardizes patient safety and off-label medical product use may void the manufacturer's warranty, this case should urge users to proceed with caution when contemplating this technique.
Collapse
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - A Robb McLean
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| |
Collapse
|
9
|
Chakravarthy M, Prabhakumar D, George A. Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery. Indian J Anaesth 2017; 61:736-743. [PMID: 28970632 PMCID: PMC5613599 DOI: 10.4103/ija.ija_346_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Multichamber pacemakers, implanted cardiac defibrillators and ventricular assist devices are frequent in current day practice. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for the anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Therefore, it is imperative to understand the pathophysiology, device characteristics and troubleshooting before embarking on anaesthetising patients with implantable cardiac electronic devices.
Collapse
Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Dattatreya Prabhakumar
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Antony George
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| |
Collapse
|
10
|
Melton BL, Howard PA, Goerdt A, Casey J. Association of Uninterrupted Oral Anticoagulation During Cardiac Device Implantation with Pocket Hematoma. Hosp Pharm 2016; 50:761-6. [PMID: 26912915 DOI: 10.1310/hpj5009-761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Implantation of permanent pacemakers (PPMs) or implantable cardiac defibrillators (ICDs) may be complicated by the development of pocket hematomas. Current practice guidelines provide little guidance to clinicians about the preferred strategy for chronic oral anticoagulation (OAC). The purpose of this study was to examine the frequency and clinical significance of pocket hematoma among patients receiving uninterrupted OAC during cardiac device implantation. METHODS This was a retrospective cohort study of adult patients undergoing cardiac device implantation between January 1, 2011, and December 31, 2012, at an academic teaching hospital. Medical records were reviewed for demographics, comorbidities, and medications. The primary outcome was development of pocket hematomas within 30 days of device implantation. Clinical significance was based on the need for additional intervention. Data were assessed using descriptive statistics, logistic regression, and chi-square tests. RESULTS The final cohort included 380 patients. The median age was 68.4 years, and 56.6% were male. Cardiovascular comorbidities were common. Among 80 patients receiving uninterrupted OAC, 71.3% were taking warfarin, 11.2% rivaroxaban, and 17.5% dabigatran. The incidence of pocket hematomas for the entire cohort was 9.7%, of which 1.3% were clinically significant. Pocket hematoma occurred in 21.4% of patients continued on OAC versus 7.7% of those not anticoagulated (P = .001). Pocket hematoma was more common among those receiving ICDs than PPMs (18.5% vs 5.7%, respectively; P < .001). CONCLUSIONS Continuing chronic OAC increased pocket hematoma formation but most were clinically insignificant. Pocket hematoma occurred irrespective of the oral anticoagulant drug used, but additional study is needed to determine comparative risks among the drugs.
Collapse
Affiliation(s)
- Brittany L Melton
- Assistant Professor, Department of Pharmacy Practice, University of Kansas School of Pharmacy , Lawrence, Kansas
| | - Patricia A Howard
- Professor and Vice Chair, Department of Pharmacy Practice, University of Kansas Medical Center , Kansas City, Kansas
| | - Abby Goerdt
- Clinical Pharmacist, University of Kansas Hospital , Kansas City, Kansas
| | - Jessica Casey
- Clinical Pharmacist, University of Kansas Hospital , Kansas City, Kansas
| |
Collapse
|
11
|
Veloso HH, Chaves JC, Sobrinho JJ. Inappropriate shocks of implantable cardioverter-defibrillator during central venous access: A preventable complication. Int J Cardiol 2016; 204:61-3. [PMID: 26655541 DOI: 10.1016/j.ijcard.2015.11.162] [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: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Henrique Horta Veloso
- Department of Cardiology (Cardioteam), Hospital do Rio, Rio de Janeiro, Brazil; National Institute of Infectology Evandro Chagas, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Jefferson Cavalcanti Chaves
- Department of Cardiology (Cardioteam), Hospital do Rio, Rio de Janeiro, Brazil; VOTCOR, Hospital São Francisco, Rio de Janeiro, Brazil
| | - Jose Jazbik Sobrinho
- Department of Cardiovascular Surgery, Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
12
|
Issues in geriatric orthopedic anesthesia. Int Anesthesiol Clin 2015; 52:126-39. [PMID: 25268869 DOI: 10.1097/aia.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Yang X, Wang Z, Zhang Y, Yin X, Hou Y. The safety and efficacy of antithrombotic therapy in patients undergoing cardiac rhythm device implantation: a meta-analysis. Europace 2015; 17:1076-84. [PMID: 25713013 DOI: 10.1093/europace/euu369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/27/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS The meta-analysis was to assess the safety and efficacy of periprocedural antithrombotic therapy and to evaluate the risk factors potentially associated with bleeding among patients undergoing cardiac implantable electronic devices implantations. METHODS AND RESULTS A systematic literature search of PubMed, EMBASE, and Cochrane Controlled Trials Register was performed. Anticoagulation and antiplatelet therapies were assessed separately. Uninterrupted anticoagulation was associated with significant lower bleeding risk compared with heparin bridging strategy [odds ratio (OR) = 0.31, 95% confidence interval (CI) 0.18-0.53, and P < 0.0001], but there was no significant difference in thromboembolic risk between these two strategies (OR = 0.82, 95% CI 0.32-2.09, and P = 0.65). The haematoma rate was significantly increased in dual antiplatelet therapy group (OR = 6.84, 95% CI 4.16-11.25, and P < 0.00001), but not in single antiplatelet therapy (OR = 1.52, 95% CI 0.93-2.46, and P = 0.09). Clopidogrel increased the risk of haematoma vs. aspirin (OR = 2.91, 95% CI 1.27-6.69, and P = 0.01). Otherwise, a lower risk of haematoma was observed in pacemaker group vs. cardiac resynchronization therapy and/or implantable cardioverter defibrillator group (OR = 0.64, 95% CI 0.50-0.82, and P = 0.0004). CONCLUSION This meta-analysis suggested that uninterrupted oral anticoagulation seems to be the better strategy, associated with a lower risk of bleeding complications rather than heparin bridging, and dual antiplatelet therapy carried a significant risk of bleeding whereas single antiplatelet therapy was relatively safe among patients undergoing cardiac implantable electronic devices implantations. Meanwhile, cardiac resynchronization therapy and/or implantable cardioverter defibrillator implantations increase the bleeding.
Collapse
Affiliation(s)
- Xiaowei Yang
- Qianfoshan Hospital of Shandong University, Jinan City, Shandong, People's Republic of China Department of Clinical Pharmacy (Seven-Year), School of Pharmaceutical Sciences, Shandong University, Jinan City, Shandong, People's Republic of China
| | - Zhongsu Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Yong Zhang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Xiangcui Yin
- Department of Science and Education, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| |
Collapse
|
14
|
|
15
|
A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia. Int J Cardiol 2015; 179:42-5. [PMID: 25464407 DOI: 10.1016/j.ijcard.2014.10.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 12/17/2022]
|
16
|
Calvagna GM, Patanè S. Cardiac rehabilitation in pacing venous occlusions. Int J Cardiol 2015; 179:248-51. [PMID: 25464458 DOI: 10.1016/j.ijcard.2014.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
| |
Collapse
|
17
|
Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2015; 178:168-70. [DOI: 10.1016/j.ijcard.2014.10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
|
18
|
|
19
|
Cardiac perforation of the right ventricle: A rare complication of pacemaker implantation. The importance of a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2014; 177:621-4. [DOI: 10.1016/j.ijcard.2014.09.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 02/08/2023]
|
20
|
Calvagna GM, Ceresa F, Patanè S. Pocket infection as a complication of a subcutaneous implantable cardioverter-defibrillator. Int J Cardiol 2014; 177:616-8. [DOI: 10.1016/j.ijcard.2014.09.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/20/2014] [Indexed: 12/15/2022]
|
21
|
Intravascular recovery of electrode fragments as a possible complication of transvenous removal intervention. Int J Cardiol 2014; 177:560-3. [DOI: 10.1016/j.ijcard.2014.08.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 01/18/2023]
|
22
|
Superior vena cava obstruction as late complication of biventricular pacemaker implantation: Surgical replacement of the malfunctioning previous leads. Int J Cardiol 2014; 176:e83-5. [DOI: 10.1016/j.ijcard.2014.07.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/26/2014] [Indexed: 11/20/2022]
|
23
|
Calvagna GM, Ceresa F, Patanè S. Subcutaneous implantable cardioverter-defibrillator in a young woman. Int J Cardiol 2014; 175:e30-2. [DOI: 10.1016/j.ijcard.2014.04.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022]
|
24
|
Calvagna GM, Patanè S. Transvenous pacemaker lead extraction in infective endocarditis. Int J Cardiol 2014; 176:511-3. [PMID: 25085380 DOI: 10.1016/j.ijcard.2014.07.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/05/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy
| |
Collapse
|
25
|
Calvagna GM, Torrisi G, Giuffrida C, Patanè S. Pacemaker, implantable cardioverter defibrillator, CRT, CRT-D, psychological difficulties and quality of life. Int J Cardiol 2014; 174:378-80. [DOI: 10.1016/j.ijcard.2014.03.187] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/29/2014] [Indexed: 11/15/2022]
|