Cardiac resynchronization therapy complications: Difference between revisions
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(New page: {{Cardiac resynchronization therapy}} {{CMG}}; {{AOEIC}}: Bhaskar Purushottam, M.D. [mailto:bpurushottam@gmail.com] '''''Synonyms and Keywords:''''' CRT ==Overview== ==Complications== Th...) |
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==Complications== | ==Complications== | ||
The performance of the CRT procedure itself can be associated with several complications | The performance of the CRT procedure itself can be associated with several complications including: #[[Bleeding]] | ||
#Infection | |||
#[[Pneumothorax]] (0.9% in CRT trials, Medicare registry<ref name="pmid16781379">{{cite journal| author=Reynolds MR, Cohen DJ, Kugelmass AD, Brown PP, Becker ER, Culler SD et al.| title=The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 12 | pages= 2493-7 | pmid=16781379 | doi=10.1016/j.jacc.2006.02.049 | pmc=PMC1800827 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781379 }} </ref> reported 1.2%), | |||
#[[Lead dislodgement]] | |||
#[[Myocardial injury]] | |||
#[[Coronary sinus]] dissection (1.3%) or perforation (1.3%)(complication rate related to coronary veins has been reported in 2%) | |||
#[[Pericardial tamponade]]. | |||
Pocket erosion, hematomas (2.4%; in routine clinical practice, the actual incidence of pocket hematomas is probably higher as the trials only reported those hematomas, which needed surgical intervention), lead fracture, lead dislodgements (CRT trials demonstrated a rate verying from 2.9% to 10.6%; the MIRACLE-ICD<ref name="pmid12771115">{{cite journal| author=Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B et al.| title=Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 20 | pages= 2685-94 | pmid=12771115 | doi=10.1001/jama.289.20.2685 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771115 }} </ref> study demonstrated a higher occurence of lead dislodgement with left ventricular lead than right atrial and right ventricular leads-6.8%, 15 and 0.6% respectively) and device infection are common post procedural complications. It is important to note that early re-intervention of pocket hematomas is associated with a 15-fold increase in infection<ref name="pmid17724263">{{cite journal| author=Klug D, Balde M, Pavin D, Hidden-Lucet F, Clementy J, Sadoul N et al.| title=Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. | journal=Circulation | year= 2007 | volume= 116 | issue= 12 | pages= 1349-55 | pmid=17724263 | doi=10.1161/CIRCULATIONAHA.106.678664 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17724263 }} </ref>. Given the proximity of the posterior wall of the left ventricle to the [[phrenic nerve]], there remains the risk of inappropriate phrenic nerve stimulation. For CRT patients, the average in-hospital mortality is 0.3% and the 30 day mortality is 0.7%. Reynolds et al.<ref name="pmid16781379">{{cite journal| author=Reynolds MR, Cohen DJ, Kugelmass AD, Brown PP, Becker ER, Culler SD et al.| title=The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. | journal=J Am Coll Cardiol | year= 2006 | volume= 47 | issue= 12 | pages= 2493-7 | pmid=16781379 | doi=10.1016/j.jacc.2006.02.049 | pmc=PMC1800827 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781379 }} </ref> showed a 1.1% in-hospital mortality in 30,984 Medicare patients undergoing CRT. This disparity in the in-hospital mortality rates can be explained by the strict inclusion criteria of the trials, where the patients are more healthier than the patients in real life practice.<ref name="pmid21867832">{{cite journal| author=van Rees JB, de Bie MK, Thijssen J, Borleffs CJ, Schalij MJ, van Erven L| title=Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices a systematic review of randomized clinical trials. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 10 | pages= 995-1000 | pmid=21867832 | doi=10.1016/j.jacc.2011.06.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21867832 }} </ref> | |||
==References== | ==References== | ||
Revision as of 00:47, 8 April 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:: Bhaskar Purushottam, M.D. [2] Synonyms and Keywords: CRT
Overview
Complications
The performance of the CRT procedure itself can be associated with several complications including: #Bleeding
- Infection
- Pneumothorax (0.9% in CRT trials, Medicare registry[1] reported 1.2%),
- Lead dislodgement
- Myocardial injury
- Coronary sinus dissection (1.3%) or perforation (1.3%)(complication rate related to coronary veins has been reported in 2%)
- Pericardial tamponade.
Pocket erosion, hematomas (2.4%; in routine clinical practice, the actual incidence of pocket hematomas is probably higher as the trials only reported those hematomas, which needed surgical intervention), lead fracture, lead dislodgements (CRT trials demonstrated a rate verying from 2.9% to 10.6%; the MIRACLE-ICD[2] study demonstrated a higher occurence of lead dislodgement with left ventricular lead than right atrial and right ventricular leads-6.8%, 15 and 0.6% respectively) and device infection are common post procedural complications. It is important to note that early re-intervention of pocket hematomas is associated with a 15-fold increase in infection[3]. Given the proximity of the posterior wall of the left ventricle to the phrenic nerve, there remains the risk of inappropriate phrenic nerve stimulation. For CRT patients, the average in-hospital mortality is 0.3% and the 30 day mortality is 0.7%. Reynolds et al.[1] showed a 1.1% in-hospital mortality in 30,984 Medicare patients undergoing CRT. This disparity in the in-hospital mortality rates can be explained by the strict inclusion criteria of the trials, where the patients are more healthier than the patients in real life practice.[4]
References
- ↑ 1.0 1.1 Reynolds MR, Cohen DJ, Kugelmass AD, Brown PP, Becker ER, Culler SD; et al. (2006). "The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators". J Am Coll Cardiol. 47 (12): 2493–7. doi:10.1016/j.jacc.2006.02.049. PMC 1800827. PMID 16781379.
- ↑ Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B; et al. (2003). "Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial". JAMA. 289 (20): 2685–94. doi:10.1001/jama.289.20.2685. PMID 12771115.
- ↑ Klug D, Balde M, Pavin D, Hidden-Lucet F, Clementy J, Sadoul N; et al. (2007). "Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study". Circulation. 116 (12): 1349–55. doi:10.1161/CIRCULATIONAHA.106.678664. PMID 17724263.
- ↑ van Rees JB, de Bie MK, Thijssen J, Borleffs CJ, Schalij MJ, van Erven L (2011). "Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices a systematic review of randomized clinical trials". J Am Coll Cardiol. 58 (10): 995–1000. doi:10.1016/j.jacc.2011.06.007. PMID 21867832.