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Complex cardiac pacing in the setting of a district general hospital: procedural success and complications
Hazim Rahbi1, Mohammed El-Din1, Mohammad Salloum1
1Kettering General Hospital , Kettering , UK.
Insights
Complex cardiac device implantation, including implantable cardiovertor defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, is safe and effective in district general hospitals. Procedural success rates are high, with manageable complication rates, supporting wider accessibility of these life-saving therapies.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Complex cardiac pacing devices like ICDs, CRT-Ps, and CRT-Ds are crucial for heart failure management.
- Device implantation can lead to rare but significant complications, potentially limiting treatment centers.
- Assessing safety and efficacy in diverse hospital settings is vital.
Purpose of the Study:
- To evaluate procedural success rates.
- To determine complication rates for complex cardiac device implantation.
- To assess outcomes in a district general hospital setting.
Main Methods:
- Retrospective review of pacing records from January 2010 to December 2011.
- Inclusion of all patients undergoing ICD, CRT-P, or CRT-D implantation.
- Data collection on clinical characteristics, implantation details, and complications.
Main Results:
- 151 devices implanted (60 CRT-Ds, 55 CRT-Ps, 36 ICDs) with a median 12-month follow-up.
- Overall transvenous procedural success rate of 99.3%.
- 9.3% of patients experienced complications, most commonly lead displacement (5.3%); no procedure-related deaths.
Conclusions:
- Complex cardiac devices can be safely and successfully implanted in district general hospitals.
- High procedural success and manageable complication rates support broader implementation.
- Clinical expertise is key to achieving positive outcomes in these settings.
Background And Purpose:
Complex cardiac pacing with either an implantable cardiovertor defibrillator (ICD) or a biventricular pacemaker with pacing only (CRT-P) or biventricular pacemaker with implantable cardiovertor defibrillator (CRT-D) plays an important role in the management of patients with heart failure. However, device implantation is associated with rare but significant complications which may limit the number of centres offering this treatment. The aim of this study is to define procedural success and complication rates associated with implantation of complex implantable cardiac devices in a district general hospital.
Methods And Subjects:
The pacing records of all the patients who underwent complex cardiac pacing (ICD, CRT-P and CRT-D) between January 2010 and December 2011 were reviewed. Information on clinical characteristics, pacing indications, venous access, implantation data, lead stability at follow-up, and procedure-related complications were obtained.
Results:
A total of 151 devices (60 CRT-Ds, 55 CRT-Ps and 36 ICDs), were implanted between January 2010 and December 2011 with a median follow-up of 12 months. Overall transvenous procedural success rate was 99.3%. 14 (9.3%) out of the 151 patients suffered a complication. There were no procedure-related deaths, and lead displacement (5.3%) was the most common complication. Other complications included pocket haematoma and phrenic nerve stimulation (1.3% and 3.4%, respectively). There were no cases of pneumothorax, cardiac tamponade, device-related infection, symptomatic venous thrombosis and stroke. Lead thresholds, in particular that of the left ventricular lead, remained stable during the follow-up period indicating persistent delivery of cardiac resynchronisation therapy in the group receiving CRT systems.
Conclusions:
In the presence of necessary clinical expertise, complex cardiac devices can be implanted successfully and with a high degree of safety in the setting of a district general hospital.
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