Cardiac resynchronization therapy complications
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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.