Cardiac resynchronization therapy complications: Difference between revisions
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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. | ||
===Common Complications=== | |||
#[[Bleeding]] | |||
#Infection | #Infection | ||
#[[Lead dislodgement]]. (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. | |||
===Rare Complications=== | |||
#[[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%), | #[[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%), | ||
#[[Myocardial injury]] | #[[Myocardial injury]] | ||
#[[Coronary sinus]] dissection (1.3%) or perforation (1.3%)(complication rate related to coronary veins has been reported in 2%) | #[[Coronary sinus]] dissection (1.3%) or perforation (1.3%)(complication rate related to coronary veins has been reported in 2%) | ||
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#[[Hematoma]]s (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). 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>. | #[[Hematoma]]s (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). 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>. | ||
#Lead fracture | #Lead fracture | ||
#Inappropriate [[phrenic nerve]] stimulation: Given the proximity of the posterior wall of the left ventricle to the [[phrenic nerve]], there remains the risk of inappropriate phrenic nerve stimulation. | #Inappropriate [[phrenic nerve]] stimulation: Given the proximity of the posterior wall of the left ventricle to the [[phrenic nerve]], there remains the risk of inappropriate phrenic nerve stimulation. | ||
Revision as of 00:53, 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.
Common Complications
- Bleeding
- Infection
- Lead dislodgement. (CRT trials demonstrated a rate verying from 2.9% to 10.6%; the MIRACLE-ICD[1] 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.
Rare Complications
- Pneumothorax (0.9% in CRT trials, Medicare registry[2] reported 1.2%),
- 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). It is important to note that early re-intervention of pocket hematomas is associated with a 15-fold increase in infection[3].
- Lead fracture
- Inappropriate phrenic nerve stimulation: Given the proximity of the posterior wall of the left ventricle to the phrenic nerve, there remains the risk of inappropriate phrenic nerve stimulation.
Mortality
For CRT patients, the average in-hospital mortality is 0.3% and the 30 day mortality is 0.7%. Reynolds et al.[2] 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
- ↑ 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.
- ↑ 2.0 2.1 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.
- ↑ 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.