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Very early discharge after cardiac implantable electronic device implantations: is this the future?

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

To limit the ever-increasing healthcare costs, strategies to minimize hospitalization length are warranted. In this perspective, early discharge (the same day or after < 24 h) post-cardiac implantable electronic device (CIED) implantation might represent a useful strategy; nevertheless, it is imperative first to understand the timing of (potentially lethal) complications and evaluate whether this is not only an effective but also a safe clinical decision.

Methods

A retrospective cohort analysis of all patients undergoing new CIED implantation from Jan 2008 to Dec 2014 was conducted. Patient demographics, comorbidities, and timing of complications post CIED implantation were evaluated, and the timing of complications was divided into intra-operative, 0–6 h (h), 6 to 24 h, and > 24 h post-implant. One-year post-implant follow-up (FU) was performed in our CIED clinic.

Results

A total of 1868 patients (68% men, average age 70 years, 85% hypertension, 39% diabetes, 57% coronary artery disease, and average left ventricular ejection fraction (LVEF) 41%) received 703 (38%) pacemaker, 448 (24%) implantable cardioverter-defibrillator (ICD), 639 (34%) cardiac resynchronization therapy (CRT) devices, and 78 (4.2%) cardiac contractility modulation. A total of 199 (11%) patients experienced 214 complications. Most (75%) occurred > 24 h post-implantation (with a median of 7 days). At univariate analysis, complications occurred more often in patients with a lower LVEF, on anticoagulation/antiplatelet therapy, and undergoing ICD/CRT-D implantation (p < 0.05 for all).

Conclusion

Most complications occur > 24 h after first time CIED implantation. Therefore, it might not be optimal to discharge patients in ≤ 24 h, unless extensive ambulatory monitoring for complications is available.

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References

  1. Wilkoff BL, Auricchio A, Brugada J, Heart Rhythm Society (HRS); European Heart Rhythm Association (EHRA); American College of Cardiology (ACC); American Heart Association (AHA); European Society of Cardiology (ESC); Heart Failure Association of ESC (HFA); Heart Failure Society of America (HFSA), et al. HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations: developed in partnership with the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA); and in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC), the Heart Failure Association of ESC (HFA), and the Heart Failure Society of America (HFSA). Endorsed by the Heart Rhythm Society, the European Heart Rhythm Association (a registered branch of the ESC), the American College of Cardiology, the American Heart Association. Europace. 2008;10:707–25.

    Article  Google Scholar 

  2. Klug D, Balde M, Pavin D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators. Circulation. 2007;116:1349–55.

    Article  Google Scholar 

  3. Trappe HJ, Gummert J. Current pacemaker and defibrillator therapy. Dtsch Arztebl Int. 2011;108:372–80.

    PubMed  PubMed Central  Google Scholar 

  4. Awada H, Geller JC, Brunelli M, Ohlow MA. Pocket related complications following cardiac electronic device implantation in patients receiving anticoagulation and/or dual antiplatelet therapy: prospective evaluation of different preventive strategies. J Interv Card Electrophysiol. 2019;54:247–55.

    Article  Google Scholar 

  5. Chen X, Wan R, Jiang W, et al. Evidence-based study on antithrombotic therapy in patients at risk of a stroke with paroxysmal atrial fibrillation. Exp Ther Med. 2013;6:413–8.

    Article  CAS  Google Scholar 

  6. de Oliveira JC, Martinelli M, Nishioka SA, Varejão T, Uipe D, Pedrosa AA, et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol. 2009;2:29–34.

    Article  Google Scholar 

  7. Apel D, El Garhy M, Geller JC, et al. Effect of intraoperative local application of 3% hydrogen peroxide on pocket infections after permanent heart rhythm device implantation: an observational study. Indian Pacing Electrophysiol J. 2018;18:159–64.

    Article  Google Scholar 

  8. Ezzat VA, Lee V, Ahsan S, et al. A systematic review of ICD complications in randomized controlled trials versus registries: is our ‘real-world’ data an underestimation? Open Heart. 2015;2:e000198.

    Article  Google Scholar 

  9. da Silva KR, Albertini CM, Crevelari ES, et al. Complications after surgical procedures in patients with cardiac implantable electronic devices: results of a prospective registry. Arq Bras Cardiol. 2016;107:245–56.

    PubMed  PubMed Central  Google Scholar 

  10. Lin YS, Hung SP, Chen PR, et al. Risk factor influencing complications. Medicine. 2014;93:e213.

    Article  Google Scholar 

  11. Kirkfeld RE, Johansen JB, Nohr EA, et al. Complications after CIED implantations. Eur H J. 2014;35:1186.

    Article  Google Scholar 

  12. Budano C, Garrone P, Castagno D, et al. Same-day CIED implantation and discharge: is it possible? The E-MOTION trial (Early MObilization after pacemaker implantaTION). Int J Cardiol. 2019;288:82–6.

    Article  Google Scholar 

  13. Villalba S, Roda J, Quesada A, Palanca V, Zaragoza C, Bataller E, et al. Retrospective study of patients who undergo pacemaker implantation in short-stay ambulatory surgery. Long-term follow-up and cost analysis. Rev Esp Cardiol. 2004;57:234–40.

    Article  Google Scholar 

  14. Zegelman M, Kreuzer J, Wagner R. Ambulatory pacemaker surgery—medical and economic advantages. Pacing Clin Electrophysiol. 1986;9:1299–303.

    Article  CAS  Google Scholar 

  15. Parahuleva MS, Soydan N, Divchev D, et al. Home monitoring after ambulatory implanted primary cardiac implantable electronic devices: the home ambulance pilot study. Clin Cardiol. 2017;40:1068–75.

    Article  Google Scholar 

  16. Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of ultrasonography and radiography in detection of hemothorax; a systematic review and meta-analysis. Emerg (Tehran). 2016;4:116–26.

    Google Scholar 

  17. Barsamyan S, Rajappan K. Central venous access techniques for cardiac implantable electronic devices. Eur J Arrhythmia Electrophysiol. 2018;4:66–73.

    Article  Google Scholar 

  18. Bhatia N, El-Chami M. Leadless pacemakers: a contemporary review. J Geriatr Cardiol. 2018;15:249–53.

    PubMed  PubMed Central  Google Scholar 

  19. Ohlow MA, Lauer B, Brunelli M, Geller JC. Incidence and predictors of pericardial effusion after permanent heart rhythm device implantation: prospective evaluation of 968 consecutive patients. Circ J. 2013;77:975–81.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, SRH Wald-Klinikum, Straße des Friedens 122, 07548, Gera, Germany

    Marc-Alexander Ohlow

  2. Department of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99437, Bad Berka, Germany

    Hassan Awada & Moritz Laubscher

  3. Department of invasive and interventional Electrophysiology, Zentralklinik, Robert-Koch-Allee 9, 99437, Bad Berka, Germany

    J. Christoph Geller

  4. Department of Cardiology and Endocrinology, Staedtisches Klinikum, 39130, Magdeburg, Germany

    Michele Brunelli

Authors
  1. Marc-Alexander Ohlow
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  2. Hassan Awada
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  3. Moritz Laubscher
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  4. J. Christoph Geller
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  5. Michele Brunelli
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Corresponding author

Correspondence to Marc-Alexander Ohlow.

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The study complied with the Declaration of Helsinki and subsequent modifications. The study protocol was approved by the institutional review board.

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Ohlow, MA., Awada, H., Laubscher, M. et al. Very early discharge after cardiac implantable electronic device implantations: is this the future?. J Interv Card Electrophysiol 60, 231–237 (2021). https://doi.org/10.1007/s10840-020-00730-0

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  • DOI: https://doi.org/10.1007/s10840-020-00730-0

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