Author + information
- Christopher Kolibash,
- Rachel Pedersen,
- Linda Francaviglia,
- Renee Koeberl,
- Jasbir Sra and
- Vikram Nangia
Implantable cardioverter-defibrillator (ICD) implants result in a significant, though small, risk of adverse patient outcomes. The ability to predict adverse outcomes would be useful for risk stratification and to establish appropriate timing of ICD procedures. We sought to determine predictors of predischarge complications and mortality after ICD implants.
We retrospectively reviewed 2,637 ICD cases from Jan. 1, 2009, to Dec. 31, 2011, within our health care system for predischarge complications and mortality. Univariate and multivariable logistic regressions were used to determine adverse outcome predictors.
Of 2,637 ICD cases, 1,068 (40.5%) were de novo ICD systems, 1,279 (48.5%) ICD generator replacements and 290 (11.0%) pacemaker upgrades to ICD. Mean age at time of implant was 66.9 ± 13 years (70.2% men). Prevalence of chronic heart failure was 87.0%, diabetes 36.9%, hypertension 80.2% and end-stage renal disease 3.1%. Mean preoperative and postprocedure length of stays (LOS) were 1.5 ± 3.8 days and 1.4 ± 3.0 days, respectively. Mean preimplant ejection fraction was 30.9 ± 12.7%. Of the 43 patients (1.6%) with adverse events, 4 (0.2%) died and 40 (1.5%) had complications. Lead dislodgement was the most common complication (n=15), followed by pneumothorax (n=7), hematoma (n=6), cardiac tamponade (n=4), coronary venous dissection (n=4), drug reaction (n=3), cerebrovascular accident (n=2), cardiac arrest (n=2), cardiac perforation not requiring surgery (n=1) and urgent cardiac surgery (n=1). Independent predictors of adverse outcomes in the multivariate model were previous pacemaker (odds ratio [OR] 2.65, p=0.01), longer preoperative LOS (per week increase, OR 1.73, p<0.01) and lower ejection fraction (per 10-unit decrease, OR 1.56, p<0.01). Male gender was protective (OR 0.47, p=0.02). Hypertension, diabetes, end-stage renal disease or prior revascularization did not significantly increase risk of adverse events.
Female patients or patients with longer LOS preimplant, prior pacemaker system or more advanced left ventricular dysfunction were at higher risk for adverse predischarge outcomes after ICD implantation.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Devices I – Identification and Avoidance of Complications Associated with Implantable Devices
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1149-30
- 2013 American College of Cardiology Foundation