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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

69/Peri-procedural complications and 3-month re-intervention rates associated with cardiac device implantation: our tertiary centre experience

Christina Menexi (Presenting Author) – University Hospital Southampton, Southampton; M Elrefai – University Hospital Southampton, Southampton; A Chua – University Hospital Southampton, Southampton; I Handa – University Hospital Southampton, Southampton; M Abouelasaad – University Hospital Southampton, Southampton; J Paisey – University Hospital Southampton, Southampton
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Published Online: Oct 9th 2012 European Journal of Arrhythmia & Electrophysiology. 2022;8(Suppl. 1):abstr69
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Article

Introduction: Cardiac implantable electronic devices (CIEDs) therapy can be associated with complications. The European Society of Cardiology guidelines on pacing recommend routine follow-up of all newly implanted devices within 72 hours of implant. The European Heart Rhythm Association expert consensus and practical guide on CIEDs recommend that a chest X-ray should be performed within 24 hours after all CIED implants to rule out pneumothorax and to document lead positions.

Purpose: We aimed to report first on the rate of peri-procedural complications associated with CIED implants at our centre and identify any patient- and procedural-related factors that are associated with peri-procedural complications. We also report on the 3-month re-intervention rates at our centre.

Methods: Consecutive CIED implants performed between January and December 2019 were retrospectively analysed. Patients’ demographics, procedural reports, device checks, post-procedure chest X-rays and further intervention procedures were obtained from the hospital records. Data analyses were performed using RStudio 1.4.1106 running R 4.0.5. Categorical data are presented as n/N (%) and continuous data as mean ± SD. Fisher’s exact and chi-squared tests were used to analyse categorical variables’ contingency tables, while continuous non-parametric data were compared using Wilcoxon rank sum test.

Results: A total of 578 patients were included in our analysis (Table 1). There were 16 (2.8%) peri-procedural complications, 7 (1.2%) pneumothoraxes, 6 (1%) pericardial effusions and 3 (0.5%) lead displacements. Axillary vein was the most common route of access (71%) followed by subclavian vein (15%) and cephalic vein (14%). All the pneumothorax cases occurred with axillary vein access; 2 out of the 3 lead displacements occurred after cephalic vein access and the other lead displacement happened after axillary access; 5 pericardial effusions followed axillary access while the remaining case followed subclavian vein access. Overall, 81.3%, 12.5% and 6.2% of the peri-procedural complications occurred after axillary, cephalic and subclavian vein access, respectively (p=0.59). The only parameter that correlated significantly with peri-procedural complications was the procedure time; the average procedure time in uncomplicated cases was 99 ± 43 minutes vs 127 ± 50 minutes in procedures associated with peri-procedural complications (p=0.02) (Table 2). The overall 3-month lead re-intervention rate was 1.2%: 4 lead revisions were required due to unsatisfactory parameters upon subsequent follow-up checks and 3 lead revisions were performed secondary to lead perforations. In 100% of the lead re-intervention cases, the primary CIED implant procedure was done via axillary vein access.

Conclusion: Axillary access for CIED implant was associated with higher rates of peri-procedural pneumothorax and subsequent lead re-intervention. The only statistically significant predictor of peri-procedural complications was the duration of the procedure. 

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