Mortality and cerebrovascular events after heart rhythm disorder management procedures

Justin Z. Lee, Jayna Ling, Nancy N. Diehl, David O. Hodge, Deepak Padmanabhan, Ammar M. Killu, Malini Madhavan, Peter Noseworthy, Suraj Kapa, Christopher J. McLeod, Yong-Mei Cha, Abhishek J. Deshmukh, Komandoor Srivathsan, Fred M. Kusumoto, Win Kuang Shen, Paul Andrew Friedman, Thomas M. Munger, Samuel J Asirvatham, Douglas L Packer, Siva Mulpuru

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Recognition of rates and causes of hard, patientcentered 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 inhospital deaths and CVEs after HRDM procedures were identifed 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 defbrillation threshold testing procedures. RESULTS: A total of 48913 patients (age, 65.7±6.6 years; 64% male) who underwent a total of 62065 HRDM procedures were included in the study. The overall mortality and CVE rates in the cohort were 0.36% (95% confdence 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 identifcation and management of cardiac tamponade even in procedures typically believed to be lower risk such as device implantation.

Original languageEnglish (US)
Pages (from-to)24-33
Number of pages10
JournalCirculation
Volume137
Issue number1
DOIs
StatePublished - Jan 1 2018

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Keywords

  • Cerebrovascular attack
  • Complications
  • Electrophysiology
  • Ischemic attack, transient
  • Mortality
  • Quality improvement
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lee, J. Z., Ling, J., Diehl, N. N., Hodge, D. O., Padmanabhan, D., Killu, A. M., Madhavan, M., Noseworthy, P., Kapa, S., McLeod, C. J., Cha, Y-M., Deshmukh, A. J., Srivathsan, K., Kusumoto, F. M., Shen, W. K., Friedman, P. A., Munger, T. M., Asirvatham, S. J., Packer, D. L., & Mulpuru, S. (2018). Mortality and cerebrovascular events after heart rhythm disorder management procedures. Circulation, 137(1), 24-33. https://doi.org/10.1161/CIRCULATIONAHA.117.030523