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Webster G, Balmert LC, Patel AB, Kociolek LK, Gevitz M, Olson R, Chaouki AS, El-Tayeb O, Monge MC, Backer C. Surveillance Cultures and Infection in 230 Pacemaker and Defibrillator Generator Changes in Pediatric and Adult Congenital Patients. World J Pediatr Congenit Heart Surg 2021; 12:331-336. [PMID: 33942684 DOI: 10.1177/2150135120988631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative infections can occur during surgical replacement of pulse generators for pacemakers and implantable cardioverter-defibrillators. The incidence of infection is poorly documented in children and patients with adult congenital heart disease. The utility of surveillance cultures obtained from device pocket swabs is unknown in this group. METHODS We reviewed surgical replacements of cardiovascular implantable pulse generators from 2010 to 2017. Two cohorts were defined. In a surveillance cohort (123 patients), aerobic and anaerobic culture swabs of the device pocket were obtained at the time of generator change. In a nonsurveillance cohort (107 patients), generator change occurred without obtaining cultures. RESULTS During 230 generator changes (mean patient age 19 years; 77% with structural congenital heart disease), two clinical infections occurred at the surgical site (0.9% incidence). Neither infection occurred in the surveillance cohort. Cultures were positive in 12 (9.8%) of 123 patients in the surveillance cohort, but 11 of 12 were likely contaminants and none were subsequently associated with clinical disease. There was no association between clinical infection or positive surveillance cultures and the location of pulse generator, the presence of other concurrent surgeries, or a history of prior pocket infection. CONCLUSIONS Clinical infection was rare after pulse generator change in children and young adults. No cases required reintervention on the pocket. Surveillance cultures did not improve clinical care. These data extend current recommendations that surveillance cultures are not required during generator change to the pediatric and young adult population.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren C Balmert
- Department of Preventive Medicine (Biostatistics), 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ami B Patel
- Division of Infectious Diseases, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Larry K Kociolek
- Division of Infectious Diseases, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Gevitz
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachael Olson
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ahmed S Chaouki
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Osama El-Tayeb
- Division of Cardiovascular Surgery, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael C Monge
- Division of Cardiovascular Surgery, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl Backer
- Section of Pediatric Cardiovascular Surgery, Cincinnati Children's, 177468UK HealthCare Kentucky Children's Hospital, Lexington, KY, USA
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Philippon F, O'Hara GE, Champagne J, Hohnloser SH, Glikson M, Neuzner J, Mabo P, Vinolas X, Kautzner J, Gadler F, Lashevsky N, Connolly SJ, Liu YY, Healey JS. Rate, Time Course, and Predictors of Implantable Cardioverter Defibrillator Infections: An Analysis From the SIMPLE Trial. CJC Open 2020; 2:354-359. [PMID: 32995720 PMCID: PMC7499364 DOI: 10.1016/j.cjco.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background The number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors. Methods The Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics. Results Within 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection. Conclusions This cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection.
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Affiliation(s)
- François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Gilles E O'Hara
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Jean Champagne
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | | | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Noa Lashevsky
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Yan Y Liu
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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3
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Krahn AD, Longtin Y, Philippon F, Birnie DH, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Gervais P, Rioux L, Hemels MEW, Bouwels LHR, van Vlies B, Wang J, Exner DV, Dorian P, Parkash R, Alings M, Connolly SJ. Prevention of Arrhythmia Device Infection Trial: The PADIT Trial. J Am Coll Cardiol 2019; 72:3098-3109. [PMID: 30545448 DOI: 10.1016/j.jacc.2018.09.068] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/09/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infection of implanted medical devices has catastrophic consequences. For cardiac rhythm devices, pre-procedural cefazolin is standard prophylaxis but does not protect against methicillin-resistant gram-positive organisms, which are common pathogens in device infections. OBJECTIVE This study tested the clinical effectiveness of incremental perioperative antibiotics to reduce device infection. METHODS The authors performed a cluster randomized crossover trial with 4 randomly assigned 6-month periods, during which centers used either conventional or incremental periprocedural antibiotics for all cardiac implantable electronic device procedures as standard procedure. Conventional treatment was pre-procedural cefazolin infusion. Incremental treatment was pre-procedural cefazolin plus vancomycin, intraprocedural bacitracin pocket wash, and 2-day post-procedural oral cephalexin. The primary outcome was 1-year hospitalization for device infection in the high-risk group, analyzed by hierarchical logistic regression modeling, adjusting for random cluster and cluster-period effects. RESULTS Device procedures were performed in 28 centers in 19,603 patients, of whom 12,842 were high risk. Infection occurred in 99 patients (1.03%) receiving conventional treatment, and in 78 (0.78%) receiving incremental treatment (odds ratio: 0.77; 95% confidence interval: 0.56 to 1.05; p = 0.10). In high-risk patients, hospitalization for infection occurred in 77 patients (1.23%) receiving conventional antibiotics and in 66 (1.01%) receiving incremental antibiotics (odds ratio: 0.82; 95% confidence interval: 0.59 to 1.15; p = 0.26). Subgroup analysis did not identify relevant patient or site characteristics with significant benefit from incremental therapy. CONCLUSIONS The cluster crossover design efficiently tested clinical effectiveness of incremental antibiotics to reduce device infection. Device infection rates were low. The observed difference in infection rates was not statistically significant. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot] [PADIT]; NCT01002911).
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Affiliation(s)
- Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Canada
| | - François Philippon
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- Division of Cardiology, St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel Degrâce
- Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Quebec, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Philippe Gervais
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Leon Rioux
- Division of Cardiology, Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Division of Cardiology, Rijnstate Hospital, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leon H R Bouwels
- Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Bob van Vlies
- Division of Cardiology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Derek V Exner
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Marco Alings
- Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research The Netherlands (WCN), Breda, the Netherlands
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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4
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Chui PW, Wang Y, Ranasinghe I, Mitiku TY, Seto AH, Rosman L, Lampert R, Minges KE, Enriquez AD, Curtis JP. Association of Physician Specialty With Long-Term Implantable Cardioverter-Defibrillator Complication and Reoperations Rates. Circ Cardiovasc Qual Outcomes 2019; 12:e005374. [PMID: 31185734 DOI: 10.1161/circoutcomes.118.005374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients undergoing implantable cardioverter-defibrillator (ICD) implantations have high rates of long-term device-related complications and reoperations. Whether physician specialty training is associated with differences in long-term outcomes following ICD implantation is unclear. Methods and Results We linked data from the National Cardiovascular Data Registry ICD Registry with Medicare fee-for-service claims to identify physicians who performed ≥10 index ICDs from 2006 to 2009. We used data from the American Board of Medical Specialties to group the specialty of the implanting physician into mutually exclusive categories: electrophysiologists, interventional cardiologists, general cardiologists, thoracic surgeons, and other specialties. Primary outcomes were long-term device-related complications requiring reoperations or hospitalizations and reoperations for reasons other than complications. We compared the cumulative incidence rates and case-mix adjusted rates of long-term outcomes of index ICD implantations across physician specialties. Our analysis had a median follow-up of 47 months and included 107 966 index ICD implantations. Electrophysiologists had the lowest rates of incident long-term device-related complications (14.1%; interventional cardiologists, 15.3%; general cardiologists, 15.4%; thoracic surgeons, 16.4%; other specialists, 15.2%; P<0.001) and reoperations for reasons other than complications (electrophysiologists, 16.7%; interventional cardiologists, 17.0%; general cardiologists, 18.0%; thoracic surgeons, 18.4%; other specialists, 18.0%; P<0.001). Compared with patients whose ICDs were implanted by electrophysiologists, patients with implantations performed by nonelectrophysiologists were at higher risk of having long-term device-related complications (relative risk for interventional cardiologists: 1.16 [95% CI, 1.08-1.25]; general cardiologists: 1.13 [1.08-1.18]; thoracic surgeons: 1.20 [1.06-1.37]; all P<0.001, but not other specialists: 1.08 [0.99-1.17]; P=0.07). Compared to patients with implantations performed by electrophysiologists, patients with implantations performed by general cardiologists and thoracic surgeons were at higher risk of reoperation for noncomplication causes (relative risk for general cardiologists: 1.10 [1.05-1.15]; thoracic surgeons: 1.16 [1.00-1.33]; both P<0.05). Conclusions Patients with ICD implantations performed by electrophysiologists had the lowest risks of having long-term device-related complications and reoperations for noncomplication causes. Consideration of physician specialty before ICD implantation may represent an opportunity to minimize long-term adverse outcomes.
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Affiliation(s)
- Philip W Chui
- Section of Internal Medicine, VA Connecticut Healthcare System, West Haven (P.W.C., L.R., A.D.E.).,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (P.W.C., L.R.)
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.W., K.E.M., J.P.C.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., R.L., A.D.E., J.P.C.)
| | - Isuru Ranasinghe
- Discipline of Medicine, University of Adelaide, South Australia, Australia (I.R.)
| | - Teferi Y Mitiku
- Department of Cardiology, UC Irvine School of Medicine, Orange, CA (T.Y.M., A.H.S.)
| | - Arnold H Seto
- Department of Cardiology, UC Irvine School of Medicine, Orange, CA (T.Y.M., A.H.S.).,Department of Medicine, VA Long Beach Health Care System, CA (A.H.S.)
| | - Lindsey Rosman
- Section of Internal Medicine, VA Connecticut Healthcare System, West Haven (P.W.C., L.R., A.D.E.).,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (P.W.C., L.R.)
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., R.L., A.D.E., J.P.C.)
| | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.W., K.E.M., J.P.C.)
| | - Alan D Enriquez
- Section of Internal Medicine, VA Connecticut Healthcare System, West Haven (P.W.C., L.R., A.D.E.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., R.L., A.D.E., J.P.C.)
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.W., K.E.M., J.P.C.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., R.L., A.D.E., J.P.C.)
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5
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LEWIS KRYSTINAB, STACEY DAWN, CARROLL SANDRAL, BOLAND LAURA, SIKORA LINDSEY, BIRNIE DAVID. Estimating the Risks and Benefits of Implantable Cardioverter Defibrillator Generator Replacement: A Systematic Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:709-22. [DOI: 10.1111/pace.12850] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 02/25/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- KRYSTINA B. LEWIS
- School of Nursing; University of Ottawa; Ottawa Canada
- University of Ottawa Heart Institute; Ottawa Canada
| | - DAWN STACEY
- School of Nursing; University of Ottawa; Ottawa Canada
- Ottawa Hospital Research Institute; Ottawa Canada
| | | | - LAURA BOLAND
- Interdisciplinary School of Health Sciences; University of Ottawa; Ottawa Canada
| | - LINDSEY SIKORA
- Health Sciences Library; University of Ottawa; Ottawa Canada
| | - DAVID BIRNIE
- University of Ottawa Heart Institute; Ottawa Canada
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6
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Diemberger I, Parisi Q, De Filippo P, Narducci ML, Zanon F, Potenza DR, Ciaramitaro G, Malacrida M, Boriani G, Biffi M. Detect Long-term Complications After ICD Replacement (DECODE): Rationale and Study Design of a Multicenter Italian Registry. Clin Cardiol 2015; 38:577-84. [PMID: 26282191 DOI: 10.1002/clc.22440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/09/2015] [Indexed: 11/06/2022] Open
Abstract
The replacement of implantable cardioverter-defibrillators (ICDs) may give rise to considerable clinical consequences, the importance of which is underrated by the medical community. Replacement-related adverse events are difficult to identify and require monitoring of both short-term complications and long-term patient outcome. The aim of this study is to perform a structured evaluation of both short- and long-term adverse events and a cost analysis of consecutive ICD replacement procedures. Detect Long-term Complications After ICD Replacement (DECODE) is a prospective, single-arm, multicenter cohort study designed to estimate long-term complication rates (at 12 months and 5 years) in patients undergoing ICD generator replacement. The study will also evaluate predictors of complications, patient management before and during the replacement procedure in clinical practice, and the costs related to use of health care resources. About 800 consecutive patients with standard indications for ICD generator replacement will be enrolled in this study. The decision to undertake generator replacement/upgrade will be made according to the investigators' own judgment (which will be recorded). Patients will be followed for 60 months through periodic in-hospital examinations or remote monitoring. Detailed data on complications related to ICD replacement in current clinical practice are still lacking. The analysis of adverse events will reveal the value of new preventive strategies, thereby yielding both clinical and economic benefits. Moreover, assessment of complication rates after ICD replacement in a real-life setting will help estimate the actual long-term cost of ICD therapy and assess the real impact of increasing ICD longevity on cost-effectiveness.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Quintino Parisi
- Cardiovascular Department, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of the Sacred Heart, Campobasso, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Lucia Narducci
- Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Gianfranco Ciaramitaro
- Department of Cardiology, A.O.U. Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | | | - Giuseppe Boriani
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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7
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Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up. Arch Cardiovasc Dis 2015; 108:367-74. [DOI: 10.1016/j.acvd.2015.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/21/2022]
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8
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Zeitler EP, Patel D, Hasselblad V, Sanders GD, Al-Khatib SM. Complications from prophylactic replacement of cardiac implantable electronic device generators in response to United States Food and Drug Administration recall: A systematic review and meta-analysis. Heart Rhythm 2015; 12:1558-64. [PMID: 25847475 DOI: 10.1016/j.hrthm.2015.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of cardiac implantable electronic device (CIED) recalls and advisories has increased over the past 3 decades, yet no consensus exists on how to best manage patients with these CIEDs, partially because rates of complications from prophylactic replacement are unknown. OBJECTIVE The purpose of this study was to establish rates of complications when recalled CIED generators are replaced prophylactically. METHODS We searched MEDLINE and the Cochrane Controlled Trials Register for reports of prophylactic replacement of recalled CIED generators. Studies with <20 subjects were excluded. We then conducted a meta-analysis of qualifying studies to determine the rates of combined major complications, mortality, and reoperation. RESULTS We identified 7 citations that met our inclusion criteria and reported ≥1 end-points of interest. Four were single center, and 3 were multicenter. Six studies collected data retrospectively (n = 1213) and 1 prospectively (n = 222). Using a random effects model to combine data from all included studies, the rate of major complications was 2.5% (95% confidence interval [CI] 1.0%-4.5%). Combining data from 6 studies reporting mortality and reoperation, the rates were 0.5% (95% CI 0.1%-0.9%) and 2.5% (95% CI 0.8%-4.5%), respectively. CONCLUSION Prophylactic replacement of recalled CIED generators is associated with a low mortality rate but nontrivial rates of other major complications similar to those reported when CIED generators are replaced for other reasons. Thus, when considering replacing a recalled CIED generator, known risks of elective generator replacement likely apply and can be weighed against risks associated with device failure.
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Affiliation(s)
- Emily P Zeitler
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical System, Durham, North Carolina
| | - Divyang Patel
- Duke University Medical System, Durham, North Carolina
| | - Vic Hasselblad
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Sana M Al-Khatib
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical System, Durham, North Carolina.
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9
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Ricci RP, Morichelli L, Quarta L, Porfili A, Magris B, Giovene L, Torcinaro S, Gargaro A. Effect of daily remote monitoring on pacemaker longevity: A retrospective analysis. Heart Rhythm 2015; 12:330-7. [DOI: 10.1016/j.hrthm.2014.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Indexed: 01/31/2023]
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10
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De Maria E, Diemberger I, Vassallo PL, Pastore M, Giannotti F, Ronconi C, Romandini A, Biffi M, Martignani C, Ziacchi M, Bonfatti F, Tumietto F, Viale P, Boriani G. Prevention of infections in cardiovascular implantable electronic devices beyond the antibiotic agent. J Cardiovasc Med (Hagerstown) 2015; 15:554-64. [PMID: 24838036 DOI: 10.2459/jcm.0000000000000008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increase in incidence/prevalence of infections of implantable pacemakers and defibrillators (implantable cardioverter defibrillator, ICD) is outweighing that of the implanting procedures, mainly favored by the changes in patient profile. Despite the high impact on patient's outcome and related costs for healthcare systems, we lack specific evidence on the preventive measures with the exception of antibiotic prophylaxis. The aim of this study is to focus on common approaches to pacemaker/ICD implantation to identify the practical preventive strategies and choices that can (potentially) impact on the occurrence of this feared complication. After a brief introduction on clinical presentation, pathogenesis, and risk factors, we will present the results from a survey on the preventive strategies adopted by different operators from the 25 centers of the Emilia Romagna region in the northern Italy (4.4 million inhabitants). These data will provide the basis for reviewing available literature on this topic and identifying the gray areas. The last part of the article will cover the available evidence about pacemaker/ICD implantation, focusing on prophylaxis of pacemaker/ICD infection as a 'continuum' starting before the surgical procedure (from indications to patient preparation), which follows during (operator, room, and techniques) and after the procedure (patient and device follow-up). We will conclude by evaluating the relationship between adherence to the available evidence and the volume of procedures of the implanting centers or operators' experience according to the results of our survey.
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Affiliation(s)
- Elia De Maria
- aCardiology Unit, 'Ramazzini Hospital', Carpi, Modena bInstitute of Cardiology, University of Bologna cCardiology Unit, 'Santa Maria della Scaletta Hospital', Imola, Bologna dCardiology Unit, 'San Secondo Hospital', Fidenza, Parma eCardiology Unit, Hospital of Ravenna, Ravenna fCardiology Unit, 'Infermi Hospital', Rimini gInstitute of Cardiology, University of Ancona, Ancona hClinic of Infective Diseases, University of Bologna, Bologna, Italy *Elia De Maria and Igor Diemberger contributed equally to the writing of the article
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11
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Krahn AD, Morissette J, Lahm R, Haddad T, Baxter WW, McVenes R, Crystal E, Ayala-Paredes F, Cameron D, Verma A, Simpson CS, Exner DV, Birnie DH. Radiographic Predictors of Lead Conductor Fracture. Circ Arrhythm Electrophysiol 2014; 7:1070-7. [DOI: 10.1161/circep.114.001612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Lead fracture is a limiting factor in high voltage lead durability. Fractures noted with the Medtronic Fidelis leads provide an opportunity to examine factors captured on implant chest x-ray that correlate with risk for lead conductor fracture. We evaluated contributory factors in a large population of fractures.
Methods and Results—
We conducted a retrospective case–control study at 8 Canadian centers that routinely capture anterior posterior and lateral chest x-rays within 2 weeks of implant. Cases were patients that experienced confirmed Medtronic Fidelis 6949 lead fracture based on standard definitions, matched one-to-one to controls for date of implant, sex, and age with normally functioning Fidelis leads from the same center. Select chart data and x-rays were collected for all patients. Radiographic measurements by ≥2 individuals per case/control were blinded to patient status. The data were analyzed using a time to failure multivariable Cox proportional hazards model with stratification for each matched pair. X-ray pairs from 111 fracture patients were compared with 111 controls (age 61.5±12.8 years, 75% male, 221 model 6949 leads). Six parameters included in the statistical analysis were significantly associated with risk of fracture, including slack/tortuosity measures, pulse generator and superior vena cava coil location, and angle of lead exit from the pocket.
Conclusions—
Pocket, intravascular and intracardiac lead characteristics on x-ray correlate with risk of lead conductor fracture. These observations may be useful to direct implant technique to optimize lead durability. Validation in larger populations and other lead models may inform the application of these results.
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Affiliation(s)
- Andrew D. Krahn
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Josée Morissette
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Ryan Lahm
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Tarek Haddad
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Walt W. Baxter
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Rick McVenes
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Eugene Crystal
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Félix Ayala-Paredes
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Doug Cameron
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Atul Verma
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Christopher S. Simpson
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - Derek V. Exner
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
| | - David H. Birnie
- From the University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.); Medtronic, Minneapolis, MN (J.M., R.L., T.H., R.M.); Medtronic, Santa Ana, CA (W.W.B.); Sunnybrook and Women’s Hospital, Toronto, Ontario, Canada (E.C.); Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada (F.A.-P.); University of Toronto, Toronto, Ontario, Canada (D.C.); Southlake Regional Hospital, Newmarket, Ontario, Canada (A.V.); Queen’s University, Kingston, Ontario, Canada (C.S.S.)
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12
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van Hemel NM. Quality of care: not hospital but operator volume of pacemaker implantations counts. Neth Heart J 2013; 22:292-4. [PMID: 24347235 PMCID: PMC4031355 DOI: 10.1007/s12471-013-0506-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Literature about pacemaker (PM) implantations shows that several clinical and technical factors determine the short- and long-term complications after the intervention. Annual hospital volume, however, does not negatively affect complications in contrast with the cumulative experience of the operator. In view of this observation, the current required number of 20 to 30 first PM implantations for cardiology training does not match standards for quality of care. In addition, concentration of implants and replacement of pacemakers to a limited number of operators per hospital to comply with the increasing demands of patients and other parties has to be seriously considered.
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Affiliation(s)
- N M van Hemel
- Utrecht University, UMC Utrecht, Utrecht, Netherlands,
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13
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Randomized Cluster Crossover Trials for Reliable, Efficient, Comparative Effectiveness Testing: Design of the Prevention of Arrhythmia Device Infection Trial (PADIT). Can J Cardiol 2013; 29:652-8. [DOI: 10.1016/j.cjca.2013.01.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/23/2022] Open
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14
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Palmisano P, Accogli M, Zaccaria M, Luzzi G, Nacci F, Anaclerio M, Favale S. Rate, causes, and impact on patient outcome of implantable device complications requiring surgical revision: large population survey from two centres in Italy. Europace 2013; 15:531-40. [PMID: 23407627 DOI: 10.1093/europace/eus337] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIMS The long-term impact of implantable device-related complications on the patient outcome has not been thoroughly evaluated. The aims of this retrospective, bi-centre study were to analyse the rate and nature of device-related complications requiring surgical revision in a large series of patients undergoing device implantation, elective generator replacement and pacing system upgrade and to systematically assess the impact of such complications on patient outcome and healthcare utilization. METHODS AND RESULTS Data from 2671 consecutive procedures (1511 device implantations, 1034 elective generator replacements, and 126 pacing system upgrades) performed between January 2006 and March 2011 were retrospectively analysed. The outcome measures recorded were complication-related mortality, number of re-operations, need for complex surgical procedures, number of re-hospitalizations, and additional hospital treatment days. Over a median follow-up of 27 months, the overall rate of complications was 2.8% per procedure-year [9.5% in cardiac resynchronisation therapy (CRT) device implantation, 6.1% in pacing system upgrade, 3.5% in implantable cardioverter defibrillator implantation, 1.7% in pacemaker implantation, and 1.7% in generator replacement). The procedure with the highest risk of complications was CRT device implantation (odds ratio: 6.6; P < 0.001); these complications primarily involved coronary sinus lead dislodgement and device infection. Patients with complications had a significantly higher number of device-related hospitalizations (2.3 ± 0.6 vs. 1.0 ± 0.1; P < 0.001) and hospital treatment days (15.7 ± 25.1 vs. 3.6 ± 1.1; P < 0.001) than those without complications. Device infection was the complication with the greatest negative impact on patient outcome. CONCLUSION Cardiac resynchronisation therapy implantation was the procedure with the highest risk of complications requiring surgical revision. Complications were associated with substantial clinical consequences and a significant increase in the number and length of hospitalizations.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, 'Card. G. Panico' Hospital, Tricase (Le), Italy.
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15
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D'Antono B, Goldfarb M, Solomon C, Sturmer M, Becker G, Essebag V, Hadjis T, Gizicki E, Gelais JS, Sas G, Côté MC, Kus T. Psychological impact of surveillance in patients with a defibrillator lead under advisory: a prospective evaluation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:221-30. [PMID: 23121081 DOI: 10.1111/pace.12040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 08/17/2012] [Accepted: 08/27/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) leads are subject to technical failures and the impact of the resulting public advisories on patient welfare is unclear. The psychological status of patients who received an advisory for their Medtronic Fidelis ICD lead (Medtronic Inc., Minneapolis, MN, USA) and followed either by self-surveillance for alarm or home monitoring with CareLink was evaluated prospectively and compared to patients with ICDs not under advisory. METHODS One hundred sixty consecutive consenting patients (90 alarms, 24 Carelinks, 46 controls) were recruited within 1.5 years of advisory notification. Advisory patients were seen immediately before being told that the automatic lead surveillance utilized since the advisory had been inadequate in warning of impending fracture, as well as 1 and 6 months after programming was optimized. Depression, anxiety, quality of life (QoL), and ICD-related concerns were assessed. RESULTS Symptoms of depression and state anxiety were experienced by 31% and 48% of patients, respectively. QoL was impaired on all subscales. No significant group differences in distress and ICD-related concerns emerged at baseline or at follow-up. At baseline, alarm patients reported greater limitations because of body pain compared to controls (P < 0.05). All patients showed a significant reduction in body pain-related QoL at the final versus first two evaluations (P < 0.001). Advisory patients were significantly less satisfied with surveillance at follow-up than at baseline (P < 0.05). CONCLUSIONS There was limited evidence for worse psychosocial functioning in those at risk for ICD lead fracture, irrespective of surveillance method. However, many control and advisory patients experienced chronic distress for which counseling may prove beneficial.
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Affiliation(s)
- Bianca D'Antono
- Research Centre, Montreal Heart Institute/Université de Montréal, Montréal, Canada.
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16
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Udo EO, van Hemel NM, Zuithoff NPA, Dijk WA, Hooijschuur CAM, Doevendans PA, Moons KGM. Pacemaker follow-up: are the latest guidelines in line with modern pacemaker practice? Europace 2012; 15:243-51. [DOI: 10.1093/europace/eus310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Implantable electrophysiologic cardiac device infections: a risk factor analysis. Eur J Clin Microbiol Infect Dis 2012; 31:3015-21. [PMID: 22923228 DOI: 10.1007/s10096-012-1655-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
The risk of cardiac device infection (CDI) is rising significantly, with several risk factors identified. The purpose of this study is to determine the rate of CDI at our center and to assess the associated risk factors, in order to define appropriate measures to prevent this complication. We retrospectively reviewed all cases of patients with CDI at St. George Hospital between February 1999 and July 2010. Each case was matched with three controls. We performed a descriptive and bivariate analysis to identify significant risk factors. Eighteen case patients and 54 control subjects met the inclusion criteria. An organism was recovered in 58 % of the cases. Significant risk factors included previous history of CDI (p < 0.001), recent manipulation (p < 0.001), trauma to the site of implant (p = 0.003), having a dual chamber/dual lead pacemaker (p = 0.002), and development of post-procedural hematoma (p = 0.012). Our findings complement the results of previous studies. We recommend a pre-procedural risk assessment and a thorough post-implantation follow-up to prevent the development of infective complications.
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18
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Mangrolia N, Nayar V, Pugh PJ. Managing anticoagulation in patients receiving implantable cardiac devices. Future Cardiol 2012. [PMID: 26203472 DOI: 10.2217/fca.11.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A substantial proportion of patients who undergo cardiac rhythm device implantation receive anticoagulation to prevent thromboembolism. Many patients have coexisting cardiovascular diseases treated with antiplatelet therapy. Anticoagulation may increase the risk of hemorrhagic complication, while withdrawal of anticoagulation may increase thromboembolic risk. In this article, we review and describe the available evidence, in order to inform best practice .
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Affiliation(s)
- Neil Mangrolia
- Box 263, Ward K2, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
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19
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BRUMBERG GENEVIEVEE, KASEER BAHAA, SHAH HEMAL, SABA SAMIR, JAIN SANDEEP. Biventricular Defibrillator Patients Have Higher Complication Rates after Revision of Recalled Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:665-71. [DOI: 10.1111/j.1540-8159.2012.03401.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Padeletti L, Mascioli G, Perini AP, Grifoni G, Perrotta L, Marchese P, Bontempi L, Curnis A. Critical appraisal of cardiac implantable electronic devices: complications and management. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:157-67. [PMID: 22915942 PMCID: PMC3417886 DOI: 10.2147/mder.s15059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients’ psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter’s dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.
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Affiliation(s)
- Luigi Padeletti
- Istituto di Clinica Medica e Cardiologia, Università degli Studi di Firenze, Italia
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21
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Abstract
Implantable cardioverter-defibrillators have been shown to improve survival by terminating life-threatening ventricular tachyarrhythmias. As the devices have become more complex, there has been an increase in the incidence of device and lead malfunction. The device manufacturers issue advisories and recalls to alert physicians of the potential for malfunction. When patients are faced with a recalled device or lead, the initial question is whether or not to replace it. A rational approach to evaluating these patients and the associated advisory can help gauge the competing risks of elective device removal or extraction versus keeping the device in place. It is important to keep in mind that the risks of replacing devices or extracting leads are not insignificant and may outweigh the risks of death from malfunction. Despite the increasing number of advisories and attention to device and lead failure, the overall reliability and efficacy of these devices for appropriate patients remains high. In general, patients should be counseled prior to implant of the potential for device and lead malfunction, and careful consideration must be employed when decisions are made to replace generators or extract leads.
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22
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Hahn S, Kim J, Choi JH, Lim SH, Kang TS, Park BE, Lee MY. Management of a remnant electrode in a patient with cardioverter-defibrillator infection after refusal of intravascular electrode removal. Korean Circ J 2011; 41:46-50. [PMID: 21359070 PMCID: PMC3040404 DOI: 10.4070/kcj.2011.41.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/27/2010] [Accepted: 11/01/2010] [Indexed: 11/23/2022] Open
Abstract
Treatments of choice for cardiac implantable electronic device (CIED) infections are the removal of the entire CIED system, control of infection, and new device implantation. Occasionally, a complete CIED removal can not be performed for several reasons, such as very old age, severe comobidity, limited life expectancy, or refusal by a patient. We encountered a male patient who developed traumatic CIED infection five years after cardioverter-defibrillator implantation. An intravenous electrode could not be removed by a simple transvenous extraction procedure, and he refused surgical removal of the remnant electrode. After control of local infection, the tips of the electrode were separated and buried between muscles, and the wound was closed with a local flap. CIED infection did not recur for 12 months even without relying on long-term antimicrobial treatment.
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Affiliation(s)
- Sunghwahn Hahn
- Division of Cardiology, Department of Internal Medicine School of Medicine, Dankook University, Cheonan, Korea
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23
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Pang HW, Campbell D, Hopman WM, Brennan FJ, Abdollah H, Redfearn DP, Simpson CS, Baranchuk A. Effectiveness and feasibility of a transtelephonic monitoring program: Implications for a time of crisis. Int J Cardiol 2010; 145:529-30. [DOI: 10.1016/j.ijcard.2010.04.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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24
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Poole JE, Gleva MJ, Mela T, Chung MK, Uslan DZ, Borge R, Gottipaty V, Shinn T, Dan D, Feldman LA, Seide H, Winston SA, Gallagher JJ, Langberg JJ, Mitchell K, Holcomb R. Complication Rates Associated With Pacemaker or Implantable Cardioverter-Defibrillator Generator Replacements and Upgrade Procedures. Circulation 2010; 122:1553-61. [PMID: 20921437 DOI: 10.1161/circulationaha.110.976076] [Citation(s) in RCA: 542] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background—
Prospective studies defining the risk associated with pacemaker or implantable cardioverter-defibrillator replacement surgeries do not exist. These procedures are generally considered low risk despite results from recent retrospective series reporting higher rates.
Methods and Results—
We prospectively assessed predefined procedure-related complication rates associated with elective pacemaker or implantable cardioverter-defibrillator generator replacements over 6 months of follow-up. Two groups were studied: those without (cohort 1) and those with (cohort 2) a planned transvenous lead addition for replacement or upgrade to a device capable of additional therapies. Complications were adjudicated by an independent events committee. Seventy-two US academic and private practice centers participated. Major complications occurred in 4.0% (95% confidence interval, 2.9 to 5.4) of 1031 cohort 1 patients and 15.3% (95% confidence interval, 12.7 to 18.1) of 713 cohort 2 patients. In both cohorts, major complications were higher with implantable cardioverter-defibrillator compared with pacemaker generator replacements. Complications were highest in patients who had an upgrade to or a revised cardiac resynchronization therapy device (18.7%; 95% confidence interval, 15.1 to 22.6). No periprocedural deaths occurred in either cohort, although 8 later procedure-related deaths occurred in cohort 2. The 6-month infection rates were 1.4% (95% confidence interval, 0.7 to 2.3) and 1.1% (95% confidence interval, 0.5 to 2.2) for cohorts 1 and 2, respectively.
Conclusions—
Pacemaker and implantable cardioverter-defibrillator generator replacements are associated with a notable complication risk, particularly those with lead additions. These data support careful decision making before device replacement, when managing device advisories, and when considering upgrades to more complex systems.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00395447.
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Affiliation(s)
- Jeanne E. Poole
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Marye J. Gleva
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Theofanie Mela
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Mina K. Chung
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Daniel Z. Uslan
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Richard Borge
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Venkateshwar Gottipaty
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Timothy Shinn
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Dan Dan
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Leon A. Feldman
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Hanscy Seide
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Stuart A. Winston
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - John J. Gallagher
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Jonathan J. Langberg
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Kevin Mitchell
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
| | - Richard Holcomb
- From the University of Washington, Seattle (J.E.P.); Washington University in St Louis, School of Medicine, St Louis, Mo (M.J.G.); Massachusetts General Hospital, Boston (T.M.); Cleveland Clinic, Cleveland, Ohio (M.K.C.); University of California Los Angeles (D.Z.U.); Abington Medical Specialists, Abington, Pa (R.B.); South Carolina Heart Center, Columbia (V.K.); Michigan Heart, Ypsilanti (T.S., S.A.W.); Piedmont Heart Institute, Atlanta, Ga (D.D.); Desert Cardiology, Rancho Mirage, Calif (L.A.F.)
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SCHWARTZ JÉRÔME, BLANGY HUGUES, ZINZIUS PIERREYVES, FREYSZ LUC, ALIOT ETIENNE, SADOUL NICOLAS. Recall Alerts in Implantable Cardioverter-Defibrillator Recipients: Implications for Patients and Physicians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:96-103. [DOI: 10.1111/j.1540-8159.2010.02918.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Borleffs CJW, Thijssen J, de Bie MK, van Rees JB, van Welsenes GH, van Erven L, Bax JJ, Cannegieter SC, Schalij MJ. Recurrent implantable cardioverter-defibrillator replacement is associated with an increasing risk of pocket-related complications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1013-9. [PMID: 20456647 DOI: 10.1111/j.1540-8159.2010.02780.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite beneficial effects of implantable cardioverter-defibrillator (ICD) therapy, limited service life results in replacement within the majority of patients. Data concerning the effect of replacement procedures on the occurrence of pocket-related adverse events are scarce. In this study, the requirement for pocket-related surgical re-interventions following ICD treatment and the effect of device replacement were evaluated. METHODS From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket-related complications requiring surgical re-intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket-related complications. RESULTS A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re-interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three-year cumulative incidence for first surgical re-intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9-5.5%). Replacement ICDs exhibited a doubled requirement for surgical re-intervention (rate ratio 2.2, 95% CI 1.5-3.0). Compared to first implanted ICDs, the occurrence of surgical re-intervention in replacements was 2.5 (95% CI 1.6-3.7) times higher for infectious and 1.7 (95% CI 0.9-3.0) for noninfectious causes. Subdivision by the number of ICD replacements showed an increase in the annual risk for surgical re-intervention, ranging from 1.5% (95% CI 1.2-1.9%) for the first, to 8.1% (95% CI 1.7-18.3%) for the fourth implanted ICD. CONCLUSIONS ICD replacement is associated with a doubled risk for pocket-related surgical re-interventions. Furthermore, the need for re-intervention increases with every consecutive replacement.
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RAMACHANDRA INDIRESHA. Impact of ICD Battery Longevity on Need for Device Replacements-Insights from a Veterans Affairs Database. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:314-9. [DOI: 10.1111/j.1540-8159.2009.02620.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NAM, Gewitz M, Newburger JW, Schron EB, Taubert KA. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010; 121:458-77. [PMID: 20048212 DOI: 10.1161/circulationaha.109.192665] [Citation(s) in RCA: 728] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening. This has prompted the study of all aspects of CIED infections. Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research.
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Should recent defibrillator and lead advisories affect decisions to refer patients for implantable cardioverter-defibrillator therapy? Curr Opin Cardiol 2010; 25:23-8. [DOI: 10.1097/hco.0b013e328333d375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tung R, Josephson ME. Implantable Cardioverter-Defibrillator Therapy for Primary Prevention of Sudden Cardiac Death: An Argument for Restraint. Card Electrophysiol Clin 2009; 1:105-116. [PMID: 28770777 DOI: 10.1016/j.ccep.2009.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although it is estimated that a total of 220,000 patients undergo implantable cardioverter-defibrillator (ICD) implantation per year, only 10% to 20% of these patients experience life-saving therapy; this leaves up to 90% of the targeted population as "nonresponders," who do not derive clinical benefit but incur all of the risks from ICD implantation. This article reviews the landmark primary prevention trials to assess the incidence of sudden death and the absolute magnitude of benefit derived from ICD therapy. The discrepancy between trial patients and real-world implementation of ICD therapy is examined, and the potential for risks incurred from ICD implantation is presented. The natural history of patients who receive appropriate ICD therapy and the durability of ICD benefit with respect to cost-effective analyses are discussed, to support the authors' position that ICD therapy should not be routinely used for the primary prevention of sudden cardiac death.
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Affiliation(s)
- Roderick Tung
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA; Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, BH 307 CHS, Los Angeles, CA 90095, USA
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Romeyer-Bouchard C, Da Costa A, Dauphinot V, Messier M, Bisch L, Samuel B, Lafond P, Ricci P, Isaaz K. Prevalence and risk factors related to infections of cardiac resynchronization therapy devices. Eur Heart J 2009; 31:203-10. [PMID: 19875388 DOI: 10.1093/eurheartj/ehp421] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cécile Romeyer-Bouchard
- Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne 42000, France
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Padeletti L, Pappone C, Curnis A, Zanotto G, Calò L, Ricciardi G, Pieragnoli P, Dondina C, Raciti G, Michelucci A. Product-experience reporting on endocardial defibrillation leads: a 4-year national perspective. Expert Rev Med Devices 2009; 6:383-8. [PMID: 19572793 DOI: 10.1586/erd.09.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The medical device industry must implement accurate programs to monitor product performance once the product is released into the market. Product-experience reports provide a means for physicians who use medical devices to provide continuous feedback to manufacturers in order to monitor device performance. We examined product-experience reports sent from Italy over 4 years (2004-2007) related to a single manufacturer's family of permanent endocardial leads (Endotak Reliance, Boston Scientific, MA, USA) used with implantable cardioverter-defibrillators. Out of 15,772 implanted leads, physicians sent in 454 (2.87%) product-experience reports. Only 126 out of 454 (28%) leads were returned to the company; most of these (101 out of 126; 80%) were related to implant procedure. Laboratory analyses of returned leads rarely showed loss of integrity (0.01%). The practice of reporting product performance and returning the device to companies should be strongly encouraged in order to better identify potential issues affecting implantable devices.
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Affiliation(s)
- Luigi Padeletti
- Institute of Internal Medicine and Cardiology, Careggi Hospital, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
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Epstein AE, Baker JH, Beau SL, Deering TF, Greenberg SM, Goldman DS. Performance of the St. Jude Medical Riata Leads. Heart Rhythm 2009; 6:204-9. [DOI: 10.1016/j.hrthm.2008.10.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
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MAHAJAN TARUN, DUBIN ANNEM, ATKINS DIANNEL, BRADLEY DAVIDJ, SHANNON KEVINM, ERICKSON CHRISTOPHERC, FRANKLIN WAYNEH, CECCHIN FRANK, BERUL CHARLESI. Impact of Manufacturer Advisories and FDA Recalls of Implantable Cardioverter Defibrillator Generators in Pediatric and Congenital Heart Disease Patients. J Cardiovasc Electrophysiol 2008; 19:1270-4. [DOI: 10.1111/j.1540-8167.2008.01259.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gould PA, Gula LJ, Champagne J, Healey JS, Cameron D, Simpson C, Thibault B, Pinter A, Tung S, Sterns L, Birnie D, Exner D, Parkash R, Skanes AC, Yee R, Klein GJ, Krahn AD. Outcome of advisory implantable cardioverter-defibrillator replacement: One-year follow-up. Heart Rhythm 2008; 5:1675-81. [DOI: 10.1016/j.hrthm.2008.09.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/17/2008] [Indexed: 11/16/2022]
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Tung R, Zimetbaum P, Josephson ME. A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death. J Am Coll Cardiol 2008; 52:1111-21. [DOI: 10.1016/j.jacc.2008.05.058] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 05/19/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
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Epstein AE, Kay GN. Another advisory: Innovation, expectations, and balancing risks. Heart Rhythm 2008; 5:643-5. [DOI: 10.1016/j.hrthm.2008.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Indexed: 10/22/2022]
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Santini M, Ricci R. News from the XIII World Congress on Cardiac Pacing and Electrophysiology focus on implantable device performance and recalls. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:613-6. [PMID: 18439178 DOI: 10.1111/j.1540-8159.2008.01050.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Massimo Santini
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
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Chihrin SM, Mohamed U, Yee R, Gula LJ, Klein GJ, Skanes AC, Krahn AD. Utility of isoproterenol in unmasking latent escape rhythm in pacemaker dependent patients undergoing pacemaker replacement. Am J Cardiol 2008; 101:631-3. [PMID: 18308011 DOI: 10.1016/j.amjcard.2007.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 10/21/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
Abstract
Pacemaker generator replacement in dependent patients may be managed with a bridging temporary pacing lead or by replacing the generator very expediently. The 2 options involve a small risk, and temporary pacing introduces additional cost. This study was conducted to explore the utility of a graduated rate-decrease protocol with isoproterenol support in unmasking an intrinsic rhythm that would obviate the 2 strategies. The protocol was used in 100 consecutive pacemaker-dependent patients (mean age 74.4 +/- 13.7 years, 56% men) who underwent permanent pacemaker replacement. Device lower rates were decremented in 1-minute intervals to 60, 50, 40, and 30 beats/min. If no intrinsic rhythm of > or =30 beats/min was observed after 1 minute, isoproterenol was infused at 1 microg/min for 2 minutes, followed by 2 microg/min for 2 minutes. Of the 100 patients, 59 demonstrated intrinsic rhythm during pacing step-down alone. Of the remaining 41 patients, 28 (68.3%) demonstrated intrinsic rhythm during isoproterenol infusion. The escape rhythm was junctional in 29%, idioventricular in 23%, conducted atrial fibrillation in 16%, and sinus in 15%. Only 13 of 100 patients (13%) failed to demonstrate adequate intrinsic rhythm after the protocol. In conclusion, this suggests that a standardized protocol to elicit an underlying rhythm in patients previously assessed as pacemaker dependent effectively minimizes the need for temporary pacing during device replacement.
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