TY - JOUR
T1 - Acute lead dislodgements and in-hospital mortality in patients enrolled in the national cardiovascular data registry implantable cardioverter defibrillator registry
AU - Cheng, Alan
AU - Wang, Yongfei
AU - Curtis, Jeptha P.
AU - Varosy, Paul D.
N1 - Funding Information:
This work was supported by the National Cardiovascular Data Registry and presented in part at the 2009 American Heart Association Scientific Sessions in Orlando, Florida, on November 16, 2009. Funding for this study also was provided in part by a Research Career Development Award ( RCD 04-115-2 to Dr. Varosy) from the Veterans Administration Office of Health Services Research and Development . Dr. Cheng served as a consultant to Boston Scientific and Medtronic and has received modest research support from Boston Scientific and modest honoraria from Boston Scientific , Biotronik , and Medtronic for participation on advisory councils and fellows' educational programs. Mr. Wang has no relationships to disclose. Dr. Curtis has modest ownership in Medtronic and receives salary support from the American College of Cardiology National Cardiovascular Data Registry. Dr. Varosy has served as a consultant to and received modest honorarium from Boston Scientific for participation on advisory councils.
PY - 2010/11/9
Y1 - 2010/11/9
N2 - Objectives: We sought to describe the incidence of acute lead dislodgements and the consequences of these events in patients enrolled in the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator (ICD) Registry. Background: Lead dislodgements are common adverse events in patients undergoing ICD implants. Little is known regarding who is at risk and the consequences of these events. Methods: Patients enrolled between April 2006 and September 2008 were included. Acute lead dislodgement was defined as movement of the lead requiring another procedure for repositioning before discharge. Results: Acute dislodgement occurred in 2,628 of 226,764 patients. Univariate variables associated with dislodgements included older age, female sex, and patients with atrial fibrillation, chronic lung disease, cerebrovascular disease, nonischemic cardiomyopathy, and lower ejection fractions (all p < 0.002). After multivariate adjustment, factors associated with an increased risk for dislodgement included New York Heart Association functional class IV heart failure, atrial fibrillation/flutter, having a cardiac resynchronization therapy-defibrillator device, and procedures performed by physicians trained under alternative pathways. A teaching/training hospital setting was not a factor (p = 0.64). Acute dislodgements had increased odds for other adverse events including cardiac arrest, cardiac tamponade, device infection, pneumothorax, and in-hospital death even after adjustment for potential confounders (all p < 0.0001). Conclusions: Acute lead dislodgements occur more often in patients with more comorbidities and in patients undergoing implants by nonelectrophysiology-trained implanters. These events were strongly associated with increased odds for in-hospital death.
AB - Objectives: We sought to describe the incidence of acute lead dislodgements and the consequences of these events in patients enrolled in the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator (ICD) Registry. Background: Lead dislodgements are common adverse events in patients undergoing ICD implants. Little is known regarding who is at risk and the consequences of these events. Methods: Patients enrolled between April 2006 and September 2008 were included. Acute lead dislodgement was defined as movement of the lead requiring another procedure for repositioning before discharge. Results: Acute dislodgement occurred in 2,628 of 226,764 patients. Univariate variables associated with dislodgements included older age, female sex, and patients with atrial fibrillation, chronic lung disease, cerebrovascular disease, nonischemic cardiomyopathy, and lower ejection fractions (all p < 0.002). After multivariate adjustment, factors associated with an increased risk for dislodgement included New York Heart Association functional class IV heart failure, atrial fibrillation/flutter, having a cardiac resynchronization therapy-defibrillator device, and procedures performed by physicians trained under alternative pathways. A teaching/training hospital setting was not a factor (p = 0.64). Acute dislodgements had increased odds for other adverse events including cardiac arrest, cardiac tamponade, device infection, pneumothorax, and in-hospital death even after adjustment for potential confounders (all p < 0.0001). Conclusions: Acute lead dislodgements occur more often in patients with more comorbidities and in patients undergoing implants by nonelectrophysiology-trained implanters. These events were strongly associated with increased odds for in-hospital death.
KW - Death
KW - Implantable cardioverter-defibrillator
KW - Lead dislodgements
KW - National Cardiovascular Data Registry
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U2 - 10.1016/j.jacc.2010.06.037
DO - 10.1016/j.jacc.2010.06.037
M3 - Article
C2 - 21050975
AN - SCOPUS:79952113281
SN - 0735-1097
VL - 56
SP - 1651
EP - 1656
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -