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Chabrak S, Haggui A, Allouche E, Ouali S, Ben Halima A, Kacem S, Krichen S, Marrakchi S, Fehri W, Mourali MS, Jabbari Z, Ben Halima M, Neffati E, Heraiech A, Slim M, Kachboura S, Gamra H, Hassine M, Kraiem S, Kammoun S, Bezdah L, Jridi G, Bouraoui H, Kammoun S, Hammami R, Chettaoui R, Ben Ameur Y, Azaiez F, Tlili R, Battikh K, Ben Slima H, Chrigui R, Fazaa S, Sanaa I, Ellouz Y, Mosrati M, Milouchi S, Jarmouni S, Ayadi W, Akrout M, Razgallah R, Neffati W, Drissa M, Charfeddine S, Abdessalem S, Abid L, Zakhama L. National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study. JMIR Res Protoc 2024; 13:e47525. [PMID: 38588529 PMCID: PMC11036188 DOI: 10.2196/47525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. OBJECTIVE The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. METHODS The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). RESULTS The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. CONCLUSIONS This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. TRIAL REGISTRATION ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/47525.
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Affiliation(s)
- Sonia Chabrak
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Abdeddayem Haggui
- Military Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | - Emna Allouche
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Sana Ouali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Afef Ben Halima
- Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | | | | | - Sonia Marrakchi
- Cardiology Department, Versailles Cardiology Center, Paris, France
| | - Wafa Fehri
- Cardiology Department, Faculty of Medicine of Tunis, Military Hospital, University of Tunis, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Zeineb Jabbari
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Manel Ben Halima
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Elyes Neffati
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Aymen Heraiech
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mehdi Slim
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Salem Kachboura
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Habib Gamra
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Majed Hassine
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Sondes Kraiem
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Sofien Kammoun
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Leila Bezdah
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Gouider Jridi
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Hatem Bouraoui
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Samir Kammoun
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Rania Hammami
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Youssef Ben Ameur
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Fares Azaiez
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Rami Tlili
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | | | - Hedi Ben Slima
- Cardiology Department, Faculty of Medicine of Tunis, Menzel Bourguiba Hospital, University of Tunis, Bizerte, Tunisia
| | - Rim Chrigui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Samia Fazaa
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Islem Sanaa
- General & Cardiovascular Clinic, Tunis, Tunisia
| | - Yassine Ellouz
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | - Sami Milouchi
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Habib Bourguiba Hospital, University of Sfax, Medenine, Tunisia
| | - Soumaya Jarmouni
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | | | | | | | - Meriem Drissa
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Selma Charfeddine
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Salem Abdessalem
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Leila Abid
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Lilia Zakhama
- Cardiology Department, Hospital of the Interior Force Security, University of Tunis, Tunis, Tunisia
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Whearty L, Lever N, Martin A. Transvenous Lead Extraction: Outcomes From a Single Centre Providing a National Service for New Zealand. Heart Lung Circ 2023; 32:1115-1121. [PMID: 37271619 DOI: 10.1016/j.hlc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/27/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND With increasing demand for cardiac implantable electronic devices there is a parallel increase in the need for transvenous lead extraction (TLE). Due to its small population, all TLE procedures in New Zealand are currently performed in a single centre, Auckland City Hospital. We analysed the clinical characteristics and outcomes of those undergoing TLE since this service was established. METHODS We performed a retrospective, single-centre cohort study of all TLE procedures between October 2015 and December 2021. Definitions from the European Lead Extraction Controlled study, Heart Rhythm Society, European Heart Rhythm Association consensus documents were used. RESULTS A total of 247 patients had 480 leads extracted, averaging 40 TLE procedures annually. Patients had a median lead dwell time of 6 (interquartile range [IQR] 3-11) years, 60 (13%) of leads had been in-situ >15 years, median age 61 (IQR 48-70) years, 73 (30%) female, 28 (11%) Māori, 23 (9%) Pasifika. Lead dysfunction (115 patients, 47%) and infection (90 patients, 37%) were the most common indications for TLE. Complete clinical and radiological success was achieved for 96% and 95%, respectively. Procedure-related complications occurred in 16 (7%) patients. Major intra-procedure complications occurred in 5 patients (2%), including 2 (1%) deaths. Death within one year of TLE occurred in 13 (26%) with systemic infection, 5 (3%) with local infection, and 5 (3%) with non-infection indications for TLE, p <0.01. CONCLUSIONS TLE is associated with high radiographic and clinical success, low complication, and low mortality rate. At our single centre providing a national service, TLE outcomes are comparable with those achieved internationally.
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Affiliation(s)
- Lauren Whearty
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nigel Lever
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Green Lane Cardiovascular Services, Auckland City Hospital, Te Whatu Ora | Te Toka Tumai-Health New Zealand, Auckland, New Zealand
| | - Andrew Martin
- Green Lane Cardiovascular Services, Auckland City Hospital, Te Whatu Ora | Te Toka Tumai-Health New Zealand, Auckland, New Zealand.
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Diaz JC, Romero J, Costa R, Cuesta A, Biase LD, Alviz I, Velasco A, Gabr M, Duque M, Marin JE, Aristizabal J, Velasquez J, Niño CD, Mazzetti H. Current practice in transvenous lead extraction in Latin America: Latin American Heart Rhythm Association survey. J Cardiovasc Electrophysiol 2021; 32:2715-2721. [PMID: 34288220 DOI: 10.1111/jce.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead-related complications. Currently, objective data on TLE in Latin America is lacking. OBJECTIVE To describe the current practice standards in Latin American centers performing TLE. METHODS An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. RESULTS A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty-nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. CONCLUSION This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.
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Affiliation(s)
| | - Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Roberto Costa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alejandro Cuesta
- Facultad de Medicina, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Luigi D Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Jorge E Marin
- Hospital Universitario San Vicente Fundación, Rionegro, Colombia
| | | | | | | | - Hector Mazzetti
- Sanatorio de La Trinidad de San Isidro, Buenos Aires, Argentina
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Foo FS, Poppe KK, Lee M, Clare GC, Stiles MK, Looi KL, Webber M, Boddington D, Jackson R, Kerr AJ. Regional variation in cardiac implantable electronic device implants trends in New Zealand over the past decade (ANZACS-QI 54). Intern Med J 2020; 52:1035-1047. [PMID: 33342067 DOI: 10.1111/imj.15165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/29/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Permanent pacemaker (PPM) and implantable cardioverter defibrillator (ICD) implant rates have increased in New Zealand over the past decade. This study aims to provide a contemporary analysis of regional variation in implant rates. METHOD New PPM and ICD implants in patients ≥15 years were identified for ten years (2009 to 2018) using procedure coding in the National Minimum Datasets, which collects all New Zealand public hospital admissions. Age-standardised new implant rates per million adult population were calculated for each of the four regions (Northern, Midland, Central and Southern) and the 20 district health boards (DHBs) across those regions. Trend analysis was performed using joinpoint regression. RESULTS New PPM implant rates increased nationally by 3.4%/year (p < 0.001). The Northern region had the highest new PPM implant rate, increasing by 4.5%/year (p < 0.001). Excluding DHBs with <50 000 people, the new PPM implant rate for 2017/2018 was highest in Counties Manukau DHB (854.3/million, 95% CI: 774.9-933.6/million) and lowest in Canterbury DHB (488.6/million, 95% CI: 438.1-539.0/million). New ICD implant rates increased nationally by 3.0%/year (p = 0.002). The Midland region had the highest new ICD implant rate, increasing by 3.8%/year (p = 0.013). Excluding DHBs with <50 000 people, the new ICD implant rate for 2017/2018 was highest in Bay of Plenty DHB (228.5/million, 95% CI: 180.4-276.6/million) and lowest in Canterbury DHB (90.2/million, 95% CI: 69.9-110.4/million). CONCLUSION There was significant variation in PPM and ICD implant rates across regions and DHBs, suggesting potential inequity in patient access across New Zealand. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fang Shawn Foo
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.,Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Katrina K Poppe
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, New Zealand
| | - Mildred Lee
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Geoffrey C Clare
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Martin K Stiles
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical School, Faculty of Medical and Health Sciences, University of Auckland
| | - Khang-Li Looi
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Matthew Webber
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Dean Boddington
- Department of Cardiology, Tauranga Hospital, Tauranga, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, New Zealand
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Foo FS, Stiles MK, Lee M, Looi KL, Clare GC, Webber M, Boddington D, Jackson R, Poppe KK, Kerr AJ. Ten-year trends in cardiac implantable electronic devices in New Zealand: a national data linkage study (ANZACS-QI 51). Intern Med J 2020; 52:614-622. [PMID: 33070422 DOI: 10.1111/imj.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implant rates for cardiac implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), have increased globally in recent decades. AIMS This is the first national study providing a contemporary analysis of national CIED implant trends by sex-specific age groups over an extended period. METHODS Patient characteristics and device type were identified for 10 years (2009-2018) using procedure coding in the National Minimum Datasets, which collects all New Zealand (NZ) public hospital admissions. CIED implant rates represent implants/million population. RESULTS New PPM implant rates increased by 4.6%/year (P < 0.001), increasing in all age groups except patients <40 years. Males received 60.1% of new PPM implants, with higher implant rates across all age groups compared with females. The annual increase in age-standardised implant rates was similar for males and females (3.4% vs 3.0%; P = 0.4). By 2018 the overall PPM implant rate was 538/million. New ICD implant rates increased by 4.2%/year (P < 0.001), increasing in all age groups except patients <40 and ≥ 80 years. Males received 78.1% of new ICD implants, with higher implant rates across all age groups compared to females. The annual increase in age-standardised implant rates was higher in males compared with females (3.5% vs 0.7%; P < 0.001). By 2018 the overall ICD implant rate was 144/million. CONCLUSION CIED implant rates have increased steadily in NZ over the past decade but remain low compared with international benchmarks. Males had substantially higher CIED implant rates compared with females, with a growing gender disparity in ICD implant rates.
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Affiliation(s)
- Fang Shawn Foo
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.,Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Martin K Stiles
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical School, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mildred Lee
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Khang-Li Looi
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Geoffrey C Clare
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Matthew Webber
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Dean Boddington
- Department of Cardiology, Tauranga Hospital, Tauranga, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Katrina K Poppe
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
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Foo FS, Lee M, Looi K, Larsen P, Clare GC, Heaven D, Stiles MK, Voss J, Boddington D, Jackson R, Kerr AJ. Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS-QI 33). J Arrhythm 2020; 36:153-163. [PMID: 32071634 PMCID: PMC7011834 DOI: 10.1002/joa3.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects nationwide data on cardiac implantable electronic devices in New Zealand (NZ). We used the registry to describe contemporary NZ use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). METHODS All ICD and CRT Pacemaker implants recorded in ANZACS-QI DEVICE between 1 January 2014 and 31 December 2017 were analyzed. RESULTS Of 1579 ICD implants, 1152 (73.0%) were new implants, including 49.0% for primary prevention and 51.0% for secondary prevention. In both groups, median age was 62 years and patients were predominantly male (81.4% and 79.2%, respectively). Most patients receiving a primary prevention ICD had a history of clinical heart failure (80.4%), NYHA class II-III symptoms (77.1%) and LVEF ≤35% (96.9%). In the secondary prevention ICD cohort, 88.4% were for sustained ventricular tachycardia or survived cardiac arrest from ventricular arrhythmia. Compared to primary prevention CRT Defibrillators (n = 155), those receiving CRT Pacemakers (n = 175) were older (median age 74 vs 66 years) and more likely to be female (38.3% vs 19.4%). Of the 427 (27.0%) ICD replacements (mean duration 6.3 years), 46.6% had received appropriate device therapy while 17.8% received inappropriate therapy. The ICD implant rate was 119 per million population with regional variation in implant rates, ratio of primary prevention ICD implants, and selection of CRT modality. CONCLUSION In contemporary NZ practice three-quarters of ICD implants were new implants, of which half were for primary prevention. The majority met current guideline indications. Patients receiving CRT pacemaker were older and more likely to be female.
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Affiliation(s)
- Fang Shawn Foo
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Mildred Lee
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Khang‐Li Looi
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Peter Larsen
- Wellington Cardiovascular Research GroupWellington HospitalWellingtonNew Zealand
| | - Geoffrey C. Clare
- Department of CardiologyChristchurch HospitalChristchurchNew Zealand
- University of OtagoChristchurchNew Zealand
| | - David Heaven
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | | | - Jamie Voss
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | - Dean Boddington
- Department of CardiologyTauranga HospitalTaurangaNew Zealand
| | | | - Andrew J. Kerr
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
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Ranasinghe I, Hossain S, Ganesan A, Krumholz HM, McGavigan A. Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation. Ann Intern Med 2020; 172:166-167. [PMID: 31958833 DOI: 10.7326/l19-0709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Isuru Ranasinghe
- Basil Hetzel Institute for Translational Research, University of Adelaide, and Central Adelaide Local Health Network, Adelaide, South Australia, Australia (I.R.)
| | - Sadia Hossain
- Basil Hetzel Institute for Translational Research and University of Adelaide, Adelaide, South Australia, Australia (S.H.)
| | - Anand Ganesan
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia (A.G., A.M.)
| | - Harlan M Krumholz
- Yale-New Haven Hospital, Yale School of Medicine, and Yale University, New Haven, Connecticut (H.M.K.)
| | - Andrew McGavigan
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia (A.G., A.M.)
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Looi KL, Gavin A, Cooper L, Dawson L, Slipper D, Lever N. Outcomes of patients with heart failure after primary prevention ICD unit generator replacement. Heart Asia 2019; 11:e011162. [PMID: 31031836 PMCID: PMC6454329 DOI: 10.1136/heartasia-2018-011162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/13/2018] [Accepted: 12/30/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Data describing outcomes after implantable cardioverter-defibrillator (ICD) unit generator replacement in patients with heart failure (HF) with primary prevention devices are limited. METHOD Data on patients with HF who underwent primary prevention ICD/cardiac resynchronisation therapy-defibrillator (CRT-D) implantation from 2007 until mid-2015 who subsequently received unit generator replacement were analysed. Outcomes assessed were mortality, appropriate ICD therapy and shock, and procedural complications. RESULTS 61 of 385 patients with HF with primary prevention ICD/CRT-D undergoing unit generator replacement were identified. Follow-up period was 1.8±1.5 years after replacement. 43 (70.5%) patients had not received prior appropriate ICD therapy prior to unit replacement. The cumulative risks of appropriate ICD therapy at 1, 3 and 5 years after unit replacement in those without prior ICD therapy were 0%, 6.2% and 50% compared with 6.2%, 59.8% and 86.6%, respectively (p=0.005) in those with prior ICD therapies. No predictive factors associated with appropriate ICD therapy after replacement could be identified. 41 (32.8%) patients no longer met guideline indications at the time of unit replacement but risks of subsequent appropriate ICD interventions were not different compared with those who continued to meet primary prevention ICD indications.The 5-year mortality risk after unit replacement was 18.4% and there were high procedural complication rates (9.8%). CONCLUSION No predictive marker successfully stratified patients no longer needing ICD support prospectively. Finding such a marker is important in decision-making about device replacement particularly given the concerns about the complication rates. These factors should be considered at the time of ICD unit replacement.
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Affiliation(s)
- Khang-Li Looi
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Gavin
- Cardiovascular Division, North Shore Hospital, Auckland, New Zealand
| | - Lisa Cooper
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Liane Dawson
- Cardiovascular Division, North Shore Hospital, Auckland, New Zealand
| | - Debbie Slipper
- Cardiovascular Division, North Shore Hospital, Auckland, New Zealand
| | - Nigel Lever
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Tichelbäcker T, Bergau L, Puls M, Friede T, Mütze T, Maier LS, Frey N, Hasenfuß G, Zabel M, Jacobshagen C, Sossalla S. Insights into permanent pacemaker implantation following TAVR in a real-world cohort. PLoS One 2018; 13:e0204503. [PMID: 30332419 PMCID: PMC6192571 DOI: 10.1371/journal.pone.0204503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) following TAVR is a frequent post interventional complication and its management remains controversial. OBJECTIVE We sought to elucidate the electrophysiological, procedural, and clinical baseline parameters that are associated with and perhaps predict the need for PPI after TAVR in a heterogeneous-valve-type real-world cohort. METHODS Overall, 494 patients receiving TAVR at our center from April 2009 to August 2015 were screened. ECG analyses and clinical parameters were collected prospectively. RESULTS Overall, 401 patients in this all-comers real-world TAVR cohort with a PPI rate of 16% were included. The mean age was 82 years, and the mean duration to PPI was 5.5 days. A large proportion of Edwards SAPIEN valves (81%), DirectFlow, CoreValve, and Portico were implanted. The main indications for PPI were atrioventricular (AV) block III, AV-block Mobitz type II, bradycardic atrial fibrillation and persistent sinus bradycardia. Between groups with and without PPI, significant differences were noted in the prevalence of post TAVR balloon dilatation, resting heart rate, QRS interval, PR interval with a cut-off of >178 ms, left anterior fascicular block and RBBB in univariate analyses. In the subsequent multiple regression analysis, post TAVR balloon dilatation and a PR interval with a cut-off of >178 ms were significant predictors of PPI. CONCLUSION This real-world cohort differs from others in its size and heterogeneous valve selection, and indicates for the first time that patients with post balloon dilatation or prolonged PR interval are at a higher risk for pacemaker dependency after TAVR.
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Affiliation(s)
- Tobias Tichelbäcker
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Leonard Bergau
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Miriam Puls
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Tobias Mütze
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Lars Siegfried Maier
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg; Regensburg, Germany
| | - Norbert Frey
- Department for Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Markus Zabel
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Samuel Sossalla
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg; Regensburg, Germany
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Looi KL, Sidhu K, Cooper L, Dawson L, Slipper D, Gavin A, Lever N. Long-term outcomes of heart failure patients who received primary prevention implantable cardioverter-defibrillator: An observational study. J Arrhythm 2017; 34:46-54. [PMID: 29721113 PMCID: PMC5828273 DOI: 10.1002/joa3.12027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 11/07/2022] Open
Abstract
Background Implantable cardioverter-defibrillator (ICD) therapy is indicated for selected heart failure patients for the primary prevention of sudden cardiac death. Little is known about the outcomes in patients selected for primary prevention device therapy in the northern region of New Zealand. Method Heart failure patients with systolic dysfunction who underwent primary prevention ICD/cardiac resynchronization therapy-defibrillator (CRT-D) implantation between January 1, 2007, and June 1, 2015, were included. Complications, mortality, and hospitalization events were reviewed. Results Three hundred and eighty-five primary prevention devices were implanted (269 ICD, 116 CRT-D). Mean age at implant was 59.1 ± 11.4 years. Mean duration of follow-up was 3.64 ± 2.17 years. The commonest cause of death was heart failure (41.8%). Only 2 patients died from sudden arrhythmic death. The 5-year heart failure mortality rate was 6%, whereas the 5-year sudden arrhythmic death rate was 0.3%. Heart failure hospitalizations were commoner in those who received ICD than CRT-D (67.7% vs 25.8%, P < .001). Maori patients have low implant rates (14%) with relatively high rates of admissions with heart failure and ventricular arrhythmia admissions. Conclusions Even in appropriately selected heart failure patients who received primary prevention devices, only a small percentage died as a result of sudden arrhythmic death. CRT-D should be the device of choice where appropriate in heart failure patients. Significant challenges remain to improve access to device therapy and maximize benefit to those who do get implanted.
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Affiliation(s)
- Khang-Li Looi
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Karishma Sidhu
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Lisa Cooper
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Liane Dawson
- Cardiovascular Division North Shore Hospital Auckland New Zealand
| | - Debbie Slipper
- Cardiovascular Division North Shore Hospital Auckland New Zealand
| | - Andrew Gavin
- Cardiovascular Division North Shore Hospital Auckland New Zealand
| | - Nigel Lever
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
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