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Perioperative complications of cardioverter-defibrillator implantation: the Emory experience
S Zaim1, M Connolly, J Roman-Gonzalez
1Department of Medicine, Emory University Hospital, Atlanta, Georgia.
Insights
Implantable cardioverter-defibrillators (ICDs) implantation for ventricular tachyarrhythmias carries significant risks. This study found a 2.7% perioperative mortality rate and notable rates of infection and arrhythmia complications.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Ventricular tachyarrhythmias pose a significant risk for sudden cardiac death.
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing these arrhythmias.
- Understanding the perioperative risks of ICD implantation is essential for patient care.
Purpose of the Study:
- To evaluate the perioperative morbidity and mortality associated with ICD implantation.
- To identify common complications following ICD procedures.
Main Methods:
- A retrospective review of 110 consecutive ICD implantations over a 5-year period.
- Analysis of patient demographics, procedural details, and postoperative outcomes.
Main Results:
- Perioperative mortality occurred in 2.7% of patients.
- Postoperative complications included new-onset atrial fibrillation/flutter (17.3%), aggravated ventricular tachyarrhythmias (19.1%), ICD system infection (2.7%), and pneumonia (4.5%).
- Other complications included significant blood loss, hematomas, and lead dislodgement.
Conclusions:
- ICD implantation is associated with an appreciable incidence of perioperative morbidity and mortality.
- Careful patient selection and perioperative management are crucial to mitigate these risks.
Abstract:
Over a 5-year period, 110 cardioverter-defibrillators (109 epicardial, 1 transvenous) were implanted consecutively in selected patients with ventricular tachyarrhythmias. The perioperative course of this patient population was examined to determine the associated morbidity and mortality of the procedure. Patients were predominantly male, with coronary artery disease and a decreased left ventricular ejection fraction. Most underwent median sternotomy for implantable cardioverter defibrillator implantation. The incidence of perioperative mortality was found to be 2.7%. New-onset atrial fibrillation or flutter occurred in 17.3% of the patients during the postoperative period and aggravation of ventricular tachyarrhythmias in 19.1%. The ICD system became infected in 2.7% of the patients and the mediastinal incision site infected in 2.4%. Pneumonia developed in 4.5%. Other complications included significant blood loss, ICD pocket hematomas, and lead dislodgement. There is an appreciable incidence of morbidity and mortality associated with ICD implantation.