Device-Implantation – Taschenhämatom nach ICD-Implantation erhöht Infektionsrisiko

In this article we discuss two cases that highlight possible complications of cardiac device implantation. In particular, our first case involves a patient who, during implantable cardioverter defibrillator (ICD) implantation, sustained injuries to her subclavian artery and vein and subsequently developed a self-resolving neuropraxia of the brachial plexus. In our second case, the patient, also during ICD implantation, had his left cephalic vein nicked during cutdown. Post-op he then developed a hematoma-induced left brachial plexus injury that also eventually self-resolved. A literature search has not shown other incidences of iatrogenic brachial plexus injuries from ICD implantation as described.

Download Full-text

Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable Cardioverter Defibrillator

Cardiology Research and Practice ◽

10.1155/2020/4375651 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Zhi-wei Hou ◽

Hai-bo Yu ◽

Yan-chun Liang ◽

Yang Gao ◽

Guo-qing Xu ◽

...

Keyword(s):

Heart Failure ◽

High Risk ◽

Implantable Cardioverter Defibrillator ◽

Severe Heart Failure ◽

Icd Implantation ◽

Soluble St2 ◽

Cardioverter Defibrillator ◽

Device Implantation ◽

All Cause Mortality

Background. Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings. Aims. This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation. Methods. Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint. Results. During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034 ). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002 ). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02–10.67]). Age (HR: 1.06 [95% CI: 1.01–1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01–1.03]) were also associated with all-cause mortality in ICD patients. Conclusions. sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.

Download Full-text

ICD implantation and device therapy: Fabry vs hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0404 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Vijapurapu ◽

A Zegard ◽

F Leyva ◽

W Bradlow ◽

A Jovanovic ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Primary Prevention ◽

Shock Therapy ◽

Left Ventricular ◽

Device Therapy ◽

Icd Implantation ◽

Device Implantation ◽

Cardiac Devices ◽

Lv Mass

Abstract Background Cardiac involvement of Fabry disease (FD) includes left ventricular hypertrophy (LVH), inflammation, arrhythmia and sudden death. There are limited data regarding potential risk predictors and no definitive criteria exist to guide implantation of cardiac devices for primary prevention. Despite phenotypic similarities between FD and hypertrophic cardiomyopathy (HCM), FD is specifically excluded from the ESC sudden cardiac death risk prediction tool used for HCM. Purpose To evaluate differences in device implantation and arrhythmic burden between advanced Fabry cardiomyopathy and HCM. Methods This multi-centre, retrospective study including genetically confirmed FD and age/gender-matched HCM patients all of whom had an implantable cardioverter defibrillator (ICD). Data was collected prior to device implantation on disease characteristics, biomarkers and CMR imaging. Arrhythmia burden and changes in therapy were captured following implantation. Results Of the UK FD population under follow-up, 50/880 had an ICD implanted (80% males, 51% non-classical mutation, mean age at device implantation 57±12 years). A comparator group included 64 age- and gender-matched HCM patients (67% males, mean age at implant 46±39 years). Baseline LV mass was greater in FD (291±97g/m2 vs 218±78g/m2, p=0.012). FD patients had higher troponin (95 vs 19ng/l, p<0.001) but similar NT-pro-BNP (1687 vs 888ng/l, p=0.086) levels. Indications for ICD insertion in FD included: presumed HCM dual pathology 14%, symptomatic NSVT 18%, asymptomatic NSVT 24%, co-existing long QT 2%, CRT-D 14%, no clear indication (primary prevention in the presence of multiple potential arrhythmic risk factors) 28%. All HCM patients were risk stratified and underwent device implantation based on an estimated 5-year SCD risk >4%. All FD patients had a SCD risk >4% using this risk calculator. Arrhythmia were more common in FD over shorter follow-up (37/50, 74% over 4.3±3.0 years vs 28/64 in HCM, 44% over 6.5±2.9 years, p=0.001). Notably, VT requiring anti-tachycardia pacing (ATP) +/− defibrillation therapy from the ICD was more frequent (FD: 14/50, 28% vs HCM: 8/64, 12%, p=0.055), as was immediate shock therapy for sustained VT (p=0.009, figure panel B). FD patients with arrhythmia were often older, had greater LV mass, a larger left atrium and a broader QRS duration. These clinical features tended to occur more frequently in FD than in the HCM group. Conclusion This study has shown that delivery of device therapy in Fabry cardiomyopathy is higher than in HCM. Despite similar rates of asymptomatic NSVT, a higher rate of ventricular arrhythmia requiring ATP/defibrillation therapy occurred in FD. Although both FD and HCM had similar risk percentages according to the ESC calculator, active troponitis in FD was double that of HCM. Funding Acknowledgement Type of funding source: None

Download Full-text

Timing of pacemaker and ICD implantation in LMNA mutation carriers

Open Heart ◽

10.1136/openhrt-2021-001622 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001622

Author(s):

Laura Helena Ollila ◽

Kjell Nikus ◽

Hannu Parikka ◽

Sini Weckström ◽

Heliö Tiina

Keyword(s):

Pacemaker Implantation ◽

Conduction System ◽

Cardiac Conduction ◽

Icd Implantation ◽

Device Implantation ◽

Lmna Mutation ◽

Mutation Carriers ◽

Younger Age ◽

Male Patients

AimsLMNA-cardiomyopathy is often associated with pathology in the cardiac conduction system necessitating device implantations. The aim was to study the timing and types of device implantations and need for re-implantations in LMNA mutation carriers.MethodsWe studied the hospital records of 60 LMNA mutation carriers concerning device implantations and re-implantations and their indications. Data were collected until April 2019.ResultsThe median follow-up time from the first ECG recording to the last clinical follow-up, transplantation, or death was 7.7 (IQR=9.1) years. Altogether 61.7% (n=37) of the LMNA mutation carriers received a pacemaker or an implantable cardioverter defibrillator (ICD), and of them 27.0% (n=10) needed a device upgrade. Notably, in some patients the upgrade took place very soon after the first implantation. The first device was implanted at an average age of 47.9 years (SD=9.5), whereas the upgrade took place at an average age of 50.3 years (SD=8.1). Most upgrades were ICD implantations. Male patients underwent device upgrade more often and at a younger age than women. By the end of follow-up, 35.0% (n=21) of the patients fulfilled echocardiographic criteria for dilated cardiomyopathy, and 90.5% of them (n=19) needed pacemaker implantation.ConclusionMost LMNA mutation carriers underwent pacemaker implantation in this study. Due to the progressive nature of LMNA-cardiomyopathy, device upgrades are quite common. An ICD should be considered when the initial device implantation is planned in an LMNA mutation carrier.

Download Full-text

Subcutaneous Implantable Cardioverter Defibrillator Explantation -- A Single Tertiary Center Experience

10.22541/au.163254752.23906760/v1 ◽

2021 ◽

Author(s):

Naga Venkata Pothineni ◽

Tharian Cherian ◽

Neel Patel ◽

Jeffrey Smietana ◽

David Frankel ◽

...

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Tertiary Referral ◽

Icd Implantation ◽

Tertiary Referral Center ◽

Cardioverter Defibrillator ◽

Device Implantation ◽

Tertiary Center ◽

Qrs Duration ◽

The Mean ◽

Selection For

Background: The subcutaneous implantable-cardioverter defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. Objectives: To assess incidence and indications for S-ICD explantation at a large tertiary referral center. Methods: We conducted a retrospective study of all S-ICD explantations performed from 2014 to 2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation, were collected. Results: A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7±20.1 months. The mean age of the patients at explantation was 44.8±15.3 years, and 42% (n=27) were female. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of the patients. The most common reason for explantation was infection (32.8%) followed by abnormal sensing (25%) and need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7±13.6 vs 42.3± 14.6 years, p = 0.005) with a wider QRS duration (111±19 ms vs 98±19 ms, p = 0.03) at device implantation compared to patients who underwent explantation for other indications. Conclusion: Incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for a third of the explantations, a significant number were due to sensing abnormalities and need for pacing. These data may have implications for patient selection for S-ICD implantation.

Download Full-text

Cardiac device implantation and device usage in Fabry and hypertrophic cardiomyopathy

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-02133-4 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Ravi Vijapurapu ◽

William Bradlow ◽

Francisco Leyva ◽

James C. Moon ◽

Abbasin Zegard ◽

...

Keyword(s):

Primary Prevention ◽

Premature Death ◽

Shock Therapy ◽

Risk Models ◽

Icd Implantation ◽

Cardiac Device ◽

Device Implantation ◽

Potential Risk Factors ◽

The Uk

Abstract Background Fabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. Results Indications for ICD in FD varied with 72% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2, p < 0.001). VT requiring therapy was more common in FD (HR 4.5, p = 0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5, p < 0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2, p = 0.004, NSVT: HR 3.1, p < 0.001). Conclusion This study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more ‘arrhythmogenic’ than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.

Download Full-text

Abstract 2430: Should All Octogenarians Who Meet Criteria Receive an Implantable Cardioverter Defibrillator?

Circulation ◽

10.1161/circ.116.suppl_16.ii_534 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kavita Phatak ◽

Kevin Makati ◽

Marian Holland ◽

Sara Baig ◽

Michael H Kim ◽

...

Keyword(s):

New England ◽

Medical Center ◽

Primary Prophylaxis ◽

Icd Implantation ◽

Icd Therapy ◽

Device Implantation ◽

The Mean ◽

The Cost ◽

Mean Time

Background: There are no upper age restrictions for ICD implantation, though guidelines state that placement should be reserved for those with expected survival of > 1 year. In octogenarians, competing comorbidities may limit the mortality benefit of ICDs. Methods: A retrospective cohort study was used to identify octogenarians who received ICD implantation and follow-up at Northwestern Memorial Hospital or Tufts New England Medical Center between 1990 and 2006. The primary endpoint was death within 1 year of implant. Results: The study identified 241 octogenarians. Mean age 83.3 ± 3.1 years, 79% male, 87% coronary disease and 35% implanted for primary prophylaxis. Mean EF 31 ± 13%, creatinine 1.49 ± 0.71 mg/dl, and mean survival was 3.9 ± 0.3 years. Death within 1 year of implant occurred in 32 (13.2%) patients. Univariate predictors of 1-year mortality included EF ≤ 20% and creatinine ≥ 1.5 mg/dl (p < 0.01 and 0.04, respectively). Cox proportional analysis demonstrated that EF ≤ 20% was the only independent predictor of death within 1 year of ICD implant [Hazard Ratio = 3.2 (95% CI 1.5– 6.5; p<0.002)] and was associated with a 48% 1-year mortality. Of these patients, 6 (19%) received appropriate ICD therapy prior to death; the mean time from therapy to death was 3 months. Conclusion: Octogenarians with EF ≤ 20% have a very high 1-year mortality despite ICD implantation. A minority of these patients will receive appropriate ICD therapy during this time. These results would be expected to have significant impact on the cost-effectiveness of ICDs and should be considered when evaluating device implantation in this population.

Download Full-text

Outcomes in Women Undergoing Electrophysiological Procedures

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.1.41 ◽

2013 ◽

Vol 2 (1) ◽

pp. 41 ◽

Cited By ~ 2

Author(s):

Pasquale Santangeli ◽

Luigi Di Biase ◽

Eloisa Basile ◽

Amin Al-Ahmad ◽

Andrea Natale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Biventricular Pacing ◽

Persistent Atrial Fibrillation ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Icd Implantation ◽

Cardiac Device ◽

Severe Left Ventricular Dysfunction ◽

Device Implantation ◽

Electrophysiological Procedures

The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

Download Full-text

Cardiac Device Implantation and Device Usage in Fabry and Hypertrophic Cardiomyopathy

10.21203/rs.3.rs-927265/v1 ◽

2021 ◽

Author(s):

Ravi Vijapurapu ◽

William Bradlow ◽

Francisco Leyva ◽

James C Moon ◽

Abbasin Zegard ◽

...

Keyword(s):

Primary Prevention ◽

Premature Death ◽

Shock Therapy ◽

Risk Models ◽

Icd Implantation ◽

Cardiac Device ◽

Device Implantation ◽

Potential Risk Factors ◽

The Uk

Abstract BackgroundFabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. ResultsIndications for ICD in FD varied with 82% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2,p<0.001). VT requiring therapy was more common in FD (HR 4.5,p=0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5,p<0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2,p=0.004, NSVT: HR 3.1,p<0.001). ConclusionThis study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more ‘arrhythmogenic’ than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.

Download Full-text

The CADI-study: Compression after device implantation - To examine the effect of a compressive dressing after device implantation or replacement focusing on the patient"s bleeding, hematomas and pain

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.152 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

C Fuglsbjerg ◽

BT Philbert ◽

N Risum ◽

M Vinther ◽

SW Christensen ◽

...

Keyword(s):

Intervention Group ◽

University Hospital ◽

Clinical Indication ◽

Control Group ◽

Icd Implantation ◽

Total N ◽

Device Implantation ◽

Increased Risk ◽

Significant Difference ◽

Randomized Intervention Study

Abstract Funding Acknowledgements University Hospital Rigshospitalet, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Denmark Background Bleeding and pocket hematomas are a known complication in pacemaker or implantable cardioverter defibrillator (ICD) implantations. Hematomas are associated with increased risk of infection and pain. Purpose To investigate whether a compressive dressing applied for three hours can prevent bleeding, pocket hematomas and pain. Method The study was a pseudo-randomized intervention study including patients scheduled for implantation or box change of a pacemaker or an ICD. In alternating months patients either received a compressive dressing (intervention group) or not (control group). Patients were excluded by the implanting physician if there was a clinical indication for a compressive dressing due to seeping bleeding. Patients were followed at the catheterization lab, for three hours at the ward and until the first outpatient control visit (1-3 months). The outcomes were: Bleeding, pocket hematomas and pain. The bleedings were graded as active bleeding or seeping bleeding or hematomas. Hematomas were measured by degree 1 to 3 (3 largest) and size (in cm). Pain was rated by the patient by numerical rank scale (NRS) from 0 to 10 (10 worst). Descriptive statistics were used. Results A total of 191 patients were included, 95 patients in the intervention group. After inclusion 24 patients of the 96 patients in the control group were excluded by the implanting physician on clinical indication for a compressive dressing. Before the intervention there were significantly more patients with bleeding (graded as: Seeping bleeding) in the intervention group (n = 25, (26.9%)) compared to the control group (n = 4, (5.6%), p <0.001). No patients had developed pocket hematomas at the end of the procedure. Furthermore, the pain score was low in both groups (Total n = 19, NRS score ≤ 2.5). Over the next three hours in the ward, there was no significant difference in the bleeding (graded as: Seeping bleeding) in the groups (intervention: n = 8 vs. control: n = 3, p = 0.55). Two patients in each group had developed a pocket hematoma after three hours (p = 0.36) and the intervention group experienced more pain (intervention: 1.7 (±2.4) vs. control: 1.1(±1.7), p= 0.02). At the outpatient control 1-3 months after implantation, there was no significant difference between the groups related to bleeding, pocket hematomas and pain. Conclusion Compressive dressing did not significantly reduce bleeding or the number of pocket hematomas after pacemaker or ICD implantation. In addition patients reported a slight increase in pain scores related to the compressive dressing. The results question routine compression after procedure, but should be validated in larger studies.

Download Full-text