Anaesthesiological support in a cardiac electrophysiology laboratory: a single-centre prospective observational study
Thibaut Trouvé-Buisson1, Lionel Arvieux, Damien Bedague
1From the Department of Anaesthesia and Intensive Care Medicine (TT-B, LA, DB, J-FP, PA, MC-B), and Department of Cardiology, Grenoble University Hospital, Grenoble, France (PD).
Insights
Patients undergoing cardiovascular implantable electronic device (CIED) implantation face significant risks, with nearly 30% experiencing complications. Anesthesiological support is crucial due to high complication rates in these fragile patients.
Area of Science:
- Cardiology
- Anesthesiology
- Medical Device Implantation
Background:
- Cardiovascular implantable electronic device (CIED) implantation has increased significantly.
- Optimal anesthetic management for these procedures remains an area of inquiry.
Purpose of the Study:
- To describe anesthetic management strategies for CIED implantation.
- To identify risk factors associated with complications during CIED procedures.
Main Methods:
- A prospective observational study was conducted at a single center.
- Data on patient characteristics, anesthetic management, and complications were collected.
- 269 patients undergoing CIED implantation were included.
Main Results:
- 29% of patients experienced at least one complication, with 27% of those being severe.
- Cardiovascular complications were more frequent and severe than respiratory complications.
- Independent risk factors for cardiovascular complications included lead extraction, NYHA class 4, ICD testing by T-wave shock, and procedure length.
Conclusions:
- Patients undergoing CIED implantation are often medically fragile, exhibiting high rates of severe complications.
- The frequency of complications and the need for deep sedation or general anesthesia underscore the necessity of anesthesiologist involvement.
Background:
Implantation of cardiovascular implantable electronic devices (CIEDs) has greatly increased during the last decade and anaesthetic management of these patients remains an open question.
Objective:
This study describes anaesthetic management and risk factors associated with complications occurring during these procedures.
Design:
A single-centre prospective observational study.
Setting:
Grenoble University Hospital, France, from May 2010 to October 2010.
Patients:
All patients admitted to the cardiac electrophysiology laboratory were included.
Intervention:
None.
Main Outcome Measures:
Clinical data, anaesthetic and medical characteristics as well as complications (respiratory or cardiovascular) and treatment were recorded by the anaesthetic nurse at the end of each procedure.
Results:
Two hundred and sixty-nine patients were included, 229 (85%) with an American Society of Anaesthesiologists (ASA) status of 3 or 4, 103 (38%) with a New York Heart Association (NYHA) functional class of 3 or 4 and 136 (51%) with a left ventricular ejection fraction of less than 40%. Two hundred and forty-seven (92%) of the patients underwent deep sedation and 12 (8%) general anaesthesia. Seventy-eight (29%) patients had at least one complication, among whom 21 (27%) had at least one considered as severe. Fifty (19%) of the patients had a respiratory complication and 46 (17%) a cardiovascular complication; the latter was more frequently severe (41 vs. 12%; P=0.001). Lead extraction [odds ratio (OR) 13.7, 95% confidence interval (CI) 3.5 to 53.3; P<0.001], NYHA status of 4 (OR 11.8, 95% CI 1.8 to 74.8; P<0.001), implantable cardioverter-defibrillator (ICD) testing by T-wave shock (OR 3.9, 95% CI 1.53 to 10.2; P=0.005) and length of procedure (OR 1.01, 95% CI 1.004 to 1.031; P=0.013) were identified as independent risk factors for cardiovascular complications.
Conclusion:
Patients requiring cardiovascular implantable electronic device (CIED) implantation were fragile with a high complication rate and a high rate of severe complications even with anaesthesiological support. These complications, as well as the need for deep sedation or general anaesthesia, clearly justify the involvement of a qualified anaesthesiologist.
Related Concept Videos
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...
01:26Cardiac Catheterization IV: Nursing Management