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Contribution of Cardiac Implantable Electronic Devices to Thrombus Formation in Patients With Chronic Thromboembolic
Rohith Nayak1, Timothy M Fernandes2, William R Auger1
1Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
Insights
The prevalence of cardiac implantable electronic devices (CIEDs) in pulmonary hypertension patients undergoing surgery was 1.7%. These patients had more distal disease and less prior VTE, suggesting CIEDs may contribute to clot formation.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Medical Devices
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition potentially treatable with pulmonary thromboendarterectomy (PTE).
- The role of cardiac implantable electronic devices (CIEDs) in thrombosis within the CTEPH population has not been previously investigated.
Purpose of the Study:
- To determine the prevalence of CIEDs in patients with CTEPH.
- To describe the disease burden associated with CIEDs in this patient group.
Main Methods:
- Retrospective review of 982 CTEPH patients who underwent PTE between 2009 and 2015.
- Analysis of pre-operative pacemaker or implantable cardioverter defibrillator (ICD) implantation.
Main Results:
- A prevalence of 1.7% for CIEDs (14 pacemakers, 3 ICDs) was observed in the 982 CTEPH patients.
- Patients with CIEDs showed a higher association with distal disease (70.6% vs. 25.8%, p=0.0002) and lower prevalence of prior venous thromboembolism (VTE) (50% vs. 78.6%, p=0.018).
- Six CIEDs were extracted intraoperatively, with five replaced by epicardial leads.
Conclusions:
- The prevalence of CIEDs in the PTE population (1.7%) is higher than in the general population (0.16%-0.47%).
- CIEDs in CTEPH patients are linked to more distal disease and less prior VTE.
- Findings suggest CIEDs might act as a nidus for small clots that embolize distally in the pulmonary vasculature.
Objectives:
This study aimed to identify the prevalence of cardiac implantable electronic devices (CIEDs) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to describe the associated disease burden.
Background:
CTEPH is a debilitating disease, now potentially curable with pulmonary thromboendarterectomy (PTE). The contribution of CIEDs to thrombosis in this patient population has not been previously studied.
Methods:
The charts of 982 CTEPH patients, who underwent PTE between January 1, 2009, and December 31, 2015 at University of California-San Diego (UCSD) Medical Center, were reviewed for pacemakers or implantable cardioverter defibrillators (ICDs) implanted before surgery.
Results:
Among 982 CTEPH patients who underwent PTE, 14 had pacemakers and 3 had ICDs, giving 17 CIEDs and a prevalence of 1.7%. Of these 17 CIEDs, 6 devices were extracted intraoperatively, and 5 of 6 devices were replaced with epicardial leads. Furthermore, of the 950 patients classified by intraoperative UCSD level, 12 of 17 (70.6%) patients with CIEDs had distal disease versus 241 of 933 (25.8%) patients without CIEDs (p = 0.0002). The prevalence of known venous thromboembolism (VTE) was 50% in CIED patients compared with 78.6% in patients without CIEDs (p = 0.018).
Conclusions:
At 1.7%, the prevalence of CIEDs in the PTE population was higher than previously reported values, which estimated CIED prevalence between 0.16% and 0.47% in the general population. Moreover, CTEPH patients with CIEDs were more strongly associated with distal disease burden and less likely to have had previous VTE, which suggested that CIEDs may be a nidus for small clots that embolize distally in the pulmonary vasculature.
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