Wound haematoma following defibrillator implantation: incidence and predictors in the Shockless Implant Evaluation (SIMPLE) trial
| Autor: | Gilles O'Hara, Stefan H. Hohnloser, Jeff S. Healey, David Wright, Valentina Kutyifa, Xavier Viñolas, Lieselot VanErven, Stuart J. Connolly, Vidal Essebag, Michael Glikson, Fredrik Gadler, Philippe Mabo, Jia Wang, Simona Masiero, Jörg Neuzner, David H. Birnie, Josef Kautzner |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Prosthesis-Related Infections medicine.medical_treatment Surgical Wound Electric Countershock 030204 cardiovascular system & hematology Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Hematoma Risk Factors Physiology (medical) medicine Odds Ratio Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Aged Chi-Square Distribution business.industry Heparin Incidence Age Factors Surgical wound Atrial fibrillation Arrhythmias Cardiac Odds ratio Middle Aged Implantable cardioverter-defibrillator medicine.disease Surgery Defibrillators Implantable Logistic Models Treatment Outcome Nonlinear Dynamics Multivariate Analysis Female Implant Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 19(6) |
| ISSN: | 1532-2092 |
| Popis: | Aims Pocket haematoma is a common complication after defibrillator [implantable cardioverter defibrillator (ICD)] implantation, which is not only painful, but also increases the risk of device-related infection, and possibly embolic events. The present study seeks to evaluate the rate and predictors of clinically significant pocket haematoma. Methods and results This study included 2500 patients receiving an ICD in the SIMPLE trial. A clinically significant pocket haematoma was defined as a haematoma that required re-operation or interruption of oral anticoagulation (OAC) therapy. Clinically significant pocket haematoma occurred in 56 of 2500 patients (2.2%) of which 6 (10.7%) developed device-related infection. Patients who developed pocket haematoma were older (mean age 67.6 ± 8.8 years vs. 62.7 ± 11.6 years, P < 0.001), were more likely to have permanent atrial fibrillation (30.4 vs. 6.7%, P < 0.001) and a history of stroke (17.9 vs. 6.7%, P = 0.004), or were more likely to receive peri-operative OAC (50.0 vs. 28.4%, P < 0.001), unfractionated heparin (16.1 vs. 5.2%, P = 0.003), or low-molecular-weight heparin (37.5 vs. 17.5%, P < 0.001). Independent predictors of wound haematoma on multivariable analysis included the use of heparin bridging (OR 2.65, 95% CI 1.48–4.73, P = 0.001), sub-pectoral location of ICD (OR 2.00, 95% CI 1.12–3.57, P =0.020), previous stroke (OR 2.47, 95% CI 1.20–5.10, P = 0.015), an upgrade from permanent pacemaker (OR 2.52, 95% CI 1.07–5.94, P = 0.035), and older age (OR 1.03, 95% CI 1.00–1.06, P = 0.049). Conclusion Pocket haematoma remains an important complication of ICD implantation and is associated with a high risk of infection. Independent predictors of pocket haematoma include heparin bridging, prior stroke, sub-pectoral placement of ICD, older age, and upgrade from a pacemaker. |
| Databáze: | OpenAIRE |
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