Lin Yu-Sheng, Hung Sheng-Ping, Chen Pei-Rung, Yang Chia-Hung, Wo Hung-Ta, Chang Po-Cheng, Wang Chun-Chieh, Chou Chung-Chuan, Wen Ming-Shien, Chung Chang-Ming, Chen Tien-Hsing
From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (YSL, CMC); Chang Gung University College of Medicine, Taoyuan, Taiwan (SPH, PRC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou, Taiwan (CHY, HTW, PCC, CCW, CCC, MSW, THC); Department of Cardiology, Chang-Gung Memorial Hospital, Xiamen, China (THC); and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University (YSL).
Medicine (Baltimore). 2014 Dec;93(27):e213. doi: 10.1097/MD.0000000000000213.
As the number of cardiac implantable electronic devices (CIEDs) is increasing annually, CIED-related complications are becoming increasingly important. The aim of the study was to assess the risks associated with CIEDs by a nationwide database. Patients were selected from the Taiwan National Health Insurance Database. Admissions for CIED implantation, replacement, and revision were evaluated and the evaluation period was 14 years. Endpoints included CIED-related infection, pneumothorax, and heart perforation. The study included 40,608 patients with a mean age of 71.8 ± 13.3 years. Regarding infection, the incidence rate was 2.45 per 1000 CIED-years. Male gender, younger age, device replacement, and previous infection were risks for infection while old age and high-volume centers (>200 per year) were protectors. The incidence of pneumothorax was 0.6%, with an increased risk in individuals who had chronic obstructive lung disease (COPD) and cardiac resynchronized therapy (CRT). The incidence of heart perforation was 0.09%, with an increased risk in individuals who had pre-operation temporal pacing and steroid use. High-volume center was found to decrease infection rate while male gender, young people, and individuals who underwent replacements were associated with an increased risk of infection. Additionally, pre-operation temporal pacing and steroid use should be avoided if possible. Furthermore, COPD patients or those who accept CRTs should be monitored closely.
随着心脏植入式电子设备（CIED）的数量逐年增加，与CIED相关的并发症变得越来越重要。本研究的目的是通过一个全国性数据库评估与CIED相关的风险。患者从台湾国民健康保险数据库中选取。对CIED植入、更换和翻修的入院情况进行评估，评估期为14年。终点包括与CIED相关的感染、气胸和心脏穿孔。该研究纳入了40608名患者，平均年龄为71.8±13.3岁。关于感染，发病率为每1000个CIED年2.45例。男性、年轻、设备更换和既往感染是感染的风险因素，而老年和高容量中心（每年>200例）是保护因素。气胸的发病率为0.6%，慢性阻塞性肺疾病（COPD）患者和接受心脏再同步治疗（CRT）的患者风险增加。心脏穿孔的发病率为0.09%，术前临时起搏和使用类固醇的患者风险增加。发现高容量中心可降低感染率，而男性、年轻人和接受设备更换的人感染风险增加。此外，应尽可能避免术前临时起搏和使用类固醇。此外，COPD患者或接受CRT的患者应密切监测。
