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Mortality and Cerebrovascular Events After Heart Rhythm Disorder Management Procedures.

Abstract：

BACKGROUND:Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures is an essential step for the development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and characterize death and CVEs (stroke or transient ischemic attack) after HRDM procedures over a 17-year period. METHODS:We performed a retrospective cohort study of all patients undergoing HRDM procedures between January 2000 and November 2016 at the Mayo Clinic. Patients from all 3 tertiary academic centers (Rochester, Phoenix, and Jacksonville) were included in the study. All in-hospital deaths and CVEs after HRDM procedures were identified and were further characterized as directly or indirectly related to the HRDM procedure. Subgroup analysis of death and CVE rates was performed for ablation, device implantation, electrophysiology study, lead extraction, and defibrillation threshold testing procedures. RESULTS:A total of 48 913 patients (age, 65.7±6.6 years; 64% male) who underwent a total of 62 065 HRDM procedures were included in the study. The overall mortality and CVE rates in the cohort were 0.36% (95% confidence interval [CI], 0.31-0.42) and 0.12% (95% CI, 0.09-0.16), respectively. Patients undergoing lead extraction had the highest overall mortality rate at 1.9% (95% CI, 1.34-2.61) and CVE rate at 0.62% (95% CI, 0.32-1.07). Among patients undergoing HRDM procedures, 48% of deaths directly related to the HDRM procedure were among patients undergoing device implantation procedures. Overall, cardiac tamponade was the most frequent direct cause of death (40%), and infection was the most common indirect cause of death (29%). The overall 30-day mortality rate was 0.76%, with the highest being in lead extraction procedures (3.08%), followed by device implantation procedures (0.94%). CONCLUSIONS:Half of the deaths directly related to an HRDM procedure were among the patients undergoing device implantation procedures, with cardiac tamponade being the most common cause of death. This highlights the importance of the development of protocols for the quick identification and management of cardiac tamponade even in procedures typically believed to be lower risk such as device implantation.

journal_name

Circulation

journal_title

Circulation

authors

Lee JZ,Ling J,Diehl NN,Hodge DO,Padmanabhan D,Killu AM,Madhavan M,Noseworthy PA,Kapa S,McLeod CJ,Cha YM,Deshmukh AJ,Srivathsan K,Kusumoto FM,Shen WK,Friedman PA,Munger TM,Asirvatham SJ,Packer DL,Mulpuru SK

doi

10.1161/CIRCULATIONAHA.117.030523

subject

Has Abstract

pub_date

2018-01-02 00:00:00

pages

24-33

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.117.030523

journal_volume

137

pub_type

杂志文章,多中心研究

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Mortality and Cerebrovascular Events After Heart Rhythm Disorder Management Procedures.