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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Feasibility of early discharge after implantable cardioverter-defibrillator procedures
Indrajit Choudhuri1, Dipan Desai, Jon Walburg
1Division of Cardiology, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA.
Insights
Same-day discharge after implantable cardioverter-defibrillator (ICD) implantation is safe for low-risk patients. This approach can reduce healthcare costs without compromising patient safety, utilizing remote monitoring for immediate post-procedure assessment.
Area of Science:
- Cardiology
- Medical Devices
- Health Economics
Background:
- Implantable cardioverter-defibrillator (ICD) procedures for primary prevention of sudden cardiac death have low complication rates.
- Current standard care mandates overnight hospital observation post-ICD implant, potentially increasing healthcare costs.
- Discharging low-risk patients soon after implantation could offer significant cost savings if complications are avoided.
Purpose of the Study:
- To assess the feasibility and safety of same-day discharge following ICD implantation in low-risk patients.
- To evaluate the efficacy of remote monitoring in ensuring lead parameter stability post-procedure.
Main Methods:
- A prospective randomized study comparing next-day discharge with overnight observation versus same-day discharge with 24-hour remote monitoring.
- Participants were primary prevention ICD candidates at low risk for complications.
- Implants utilized standard cephalic vein access, with randomization after 4-hour observation and device interrogation.
Main Results:
- 71 patients (mean age 62, 79% male) were included; most common indication was ischemic cardiomyopathy.
- No acute complications were observed in the same-day discharge group.
- One patient in the next-day discharge group developed pneumothorax; remote monitoring data was comparable to initial post-implant parameters.
Conclusions:
- Same-day discharge following ICD implantation is a viable strategy for carefully selected low-risk patients.
- Remote monitoring effectively ensures lead parameter stability in the immediate postoperative period, supporting same-day discharge protocols.
Introduction:
Registry data demonstrate considerably low complication rates after implantable cardioverter-defibrillator (ICD) procedures for primary prevention of sudden death. Yet standard of care includes postimplant overnight in-hospital observation that may levy substantial unnecessary financial burden on health care systems. In appropriate patients, discharge soon after implant could translate into significant cost savings, if such practice does not result in complications. We applied a simple clinical algorithm to assess feasibility of discharge on the same day of ICD implantation in patients at low risk for procedural complications.
Methods:
We prospectively randomized primary prevention ICD candidates at low risk for complications (not pacing-dependent or requiring bridging heparin anticoagulation) to next-day discharge with overnight in-hospital observation, or same-day discharge with remote monitoring for 24 hours after ICD implant. Implants were performed via cephalic vein access, and randomization occurred after 4-hours clinical observation and device interrogation. All patients were followed for a minimum of 6 weeks to assess acute procedural complications.
Results:
71 patients comprised the study cohort (mean age 62, 79% male) after 3 were excluded. The most common indication for ICD implant was ischemic cardiomyopathy with ejection fraction ≤35%. Device data obtained through 24-hour remote monitoring was comparable to 4-hour postimplant parameters in same-day discharge patients. No acute complications occurred in same-day discharge patients; 1 next-day discharge patient developed pneumothorax.
Conclusion:
ICD implantation with same-day discharge is reasonable in patients at low risk for complications. Remote monitoring can be useful in indicating lead-parameter stability during the immediate postoperative period.
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