Safety of Outpatient Implantation of the Implantable Cardioverter-defibrillator

Impact of Coronavirus Disease 2019 on Cardiac Arrhythmia Care: Experience of a Spanish Tertiary Hospital During the Health Crisis Triggered by the First Wave of the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a deep restructuring of cardiovascular care, especially in the setting of cardiac arrhythmia units, which are characterized by a wide variety of clinical and interventional activities. We describe the experience of a large university hospital deeply hit during the COVID-19 health crisis (first outbreak of the pandemic), focusing on the exceptional measures implemented and their impact in terms of outcomes. We performed a retrospective study comparing the human and structural resources and the activity of a cardiac arrhythmia unit in a Spanish tertiary hospital for two consecutive periods: from January 12, 2020, to March 8, 2020 (“pre-COVID stage”), and from March 9, 2020, to May 2, 2020 (“COVID stage”). Data were contextualized within the number of confirmed COVID-19 cases in the region of Madrid. The measures implemented were promotion of non–face-to-face consultations, selection of urgent procedures, design of a “COVID-free” circuit for outpatient interventions, and protocolization for patients with COVID-19. A total of 3,526 consultations and 362 procedures were performed. During the COVID stage, the number of consultations remained stable, and the electrophysiology rooms’ activity decreased by 55.2% with a relative increase in the number of urgent-hospitalized cases attended (11.8% COVID-19-positive patients). The electrophysiology rooms’ activity returned to “normal” in the last week of the COVID stage, with no contagion being detected among patients or professionals. In conclusion, the measures implemented allowed us to respond safely and efficiently to the health care needs of patients with arrhythmias during the COVID-19 crisis and may be useful for other institutions facing similar situations.

[Structural requirements and prerequisites for outpatient implantation of defibrillators, devices for cardiac resynchronization and event recorders]

Die Möglichkeiten der ambulanten Implantation von Defibrillatoren, Geräten zur kardialen Resynchronisation und Ereignisrekordern („cardiac implantable electronic devices“, CIEDs) gewinnen zunehmend an Bedeutung. In Deutschland existieren aktuell vereinzelte Möglichkeiten zur ambulanten Implantation. Es fehlt allerdings an einheitlichen, anerkannten und verbindlichen Qualitätskriterien sowie an Grundzügen vertraglicher Gestaltungen. Der vorliegende Artikel stellt einen Einblick in die aktuellen Vertragskonstellationen zur ambulanten Operation bereit und definiert ein erstes, holistisches Qualitätskonzept für ambulante Implantationen von CIEDs. Im Zentrum steht das Ziel, einen Diskurs in der Fachgesellschaft anzustoßen, um ein abgestimmtes, verbindliches Qualitätskonzept zu definieren. Dieses sollte als Grundlage für zukünftige Leistungen der ambulanten Implantation dienen, die Leistungen vergleichbar machen und einen Beitrag zum langfristigen Nachweis der Evidenz leisten.

Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes

BACKGROUND

Implantable cardioverter-defibrillator (ICD) implantation is often an elective outpatient procedure, but previous studies have shown that approximately 30% are performed during acute hospitalizations.

PURPOSE

This study aims to identify predictors of acute hospitalization versus elective outpatient ICD implantation and evaluate differential clinical outcomes.

METHODS

We studied 327 first-time ICD recipients between 2011 and 2015. All patients receiving a primary prevention ICD were optimized on guideline directed medical therapy (GDMT) prior to consideration for device implantation. Using multivariate logistic regression, we examined predictors of ICD implantation during acute hospitalization. Cox proportional hazard regression was used adjusting for patient characteristics to examine associations with clinical outcomes including complications, device therapy, heart failure re-admission, and death.

RESULTS

Of all patients, 132 (40.3%) underwent ICD implantation during acute hospitalization, most frequently performed for secondary prevention (n = 76, 57.6%). The most common reason for acute hospitalization ICD implantation in primary prevention patients was an indication for pacing (n = 20, 35.7%). In multivariable adjusted models, secondary prevention indication, non-single chamber device, NYHA class IV symptoms, lower diastolic blood pressure, higher BUN, and lower hemoglobin were significant predictors of ICD implantation during an acute hospitalization. In univariate analysis, acute hospitalization ICD implantation was associated with a higher risk of heart failure re-admission (HR = 1.6, 95% CI 1.1-2.4) and mortality (HR = 3.0, 95% CI 1.1-8.0) but no difference in risk of ICD therapy (HR = 1.4, 95% CI 0.9-2.3) or adverse events (HR = 1.1, 95% CI 0.6-2.1). After multivariable adjustment for potential confounders, all outcomes were no different between acute hospitalization versus elective outpatient ICD recipients.

CONCLUSIONS

Among first-time ICD recipients, specific clinical characteristics predicted acute hospitalization ICD implantation. After adjustment for potential confounders, acute hospitalization ICD implantation was not associated with increased risk of morbidity or mortality.