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Mortality and Cerebrovascular Events After Heart Rhythm Disorder Management Procedures
Justin Z Lee1, Jayna Ling1, Nancy N Diehl2
1Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ (J.Z.L., J.L., K.S., W.-K.S., S.K.M.).
Insights
Heart rhythm disorder management (HRDM) procedures have low death and cerebrovascular event (CVE) rates. Cardiac tamponade is a leading cause of death after device implantation, necessitating improved management protocols.
Area of Science:
- Cardiology
- Electrophysiology
- Patient Safety
Background:
- Quality improvement in electrophysiology requires understanding patient outcomes after heart rhythm disorder management (HRDM).
- Assessing death and cerebrovascular events (CVEs) after HRDM procedures is crucial for developing better care standards.
- This study analyzes hard, patient-centered outcomes following HRDM over a 17-year period.
Purpose of the Study:
- To assess and characterize the rates and causes of death and CVEs after HRDM procedures.
- To evaluate outcomes across various HRDM procedures including ablation and device implantation.
- To identify specific risks associated with different types of HRDM procedures.
Main Methods:
- A retrospective cohort study included 48,913 patients undergoing 62,065 HRDM procedures from 2000 to 2016.
- In-hospital deaths and CVEs were identified and categorized as directly or indirectly related to the procedure.
- Subgroup analyses examined rates for ablation, device implantation, electrophysiology studies, lead extraction, and defibrillation threshold testing.
Main Results:
- Overall mortality and CVE rates were 0.36% and 0.12%, respectively.
- Lead extraction procedures showed the highest mortality (1.9%) and CVE (0.62%) rates.
- Cardiac tamponade (40%) was the most frequent direct cause of death, predominantly in device implantation procedures.
Conclusions:
- Device implantation procedures accounted for nearly half of HRDM-related deaths, with cardiac tamponade as the primary cause.
- The findings underscore the need for enhanced protocols for rapid identification and management of cardiac tamponade, even in perceived lower-risk procedures.
- Improving patient safety in HRDM requires focused attention on specific procedural risks and complications.
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.
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