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Cardiac perforation during ICD lead implantation may result in serious adverse events. We sought to describe predictors of cardiac perforation and consequent outcomes in those with the complication.
We studied 440,251 first-time ICD recipients in the ICD Registry™ implanted between January, 2006 and September, 2011. Using hierarchical multivariable logistic regression adjusting for patient, implanting physician, and hospital characteristics, we examined the predictors of cardiac perforation (perforation or tamponade) and its association with other major complications, length of hospital stay, and mortality.
Cardiac perforation occurred in 625 patients (0.14%). After multivariable adjustment, older age, female sex, LBBB, higher NYHA class, higher LVEF, and non-single chamber ICD implant were associated with an increased odds of cardiac perforation. Conversely, AF, diabetes, previous CABG, and higher physician procedural volume were associated with a lower odds of perforation (all p values <0.05). ICD recipients with cardiac perforation had a greater odds of other major complications (cardiac arrest, myocardial infarction, or infection), hospital stay >3 days, and death (Figure).
In a large population of ICD recipients, cardiac perforation was associated with a profoundly increased risk of other major complications, prolonged hospital stays, and death. Specific patient and implanter characteristics predicted cardiac perforation risk.
Oral Contributions West, Room 3009
Saturday, March 09, 2013, 9:00 a.m.-9:15 a.m.
Session Title: Management Issues in the Pacemaker and ICD Patient
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 903-7
- 2013 American College of Cardiology Foundation