Filbey Kevin, Sedaghat-Hamedani Farbod, Kayvanpour Elham, Xynogalos Panagiotis, Scherer Daniel, Meder Benjamin, Katus Hugo A, Zitron Edgar
Department of Medicine III, Universitätsklinikum Heidelberg, INF 410, 69120, Heidelberg, Germany.
DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany.
Herz. 2020 Nov;45(7):696-702. doi: 10.1007/s00059-020-04910-6. Epub 2020 Mar 13.
Postcardiac injury syndrome (PCIS) is an inflammatory complication that derives from injury to the epicardium, myocardium, or endocardium. It occurs after trauma, myocardial infarction, percutaneous coronary intervention, cardiac surgery, intracardiac ablation, and implantation of cardiac implantable electronic device (CIED). In this study we assessed the incidence of PCIS after CIED implantation and its possible risk factors.
All patients who received CIED implantation at Heidelberg University Hospital between 2000 and 2014 were evaluated (n = 4989 patients). Clinical data including age, sex, underlying cardiac disease, type of implanted CIED, location of electrode implantation, clinical symptoms, time of symptom onset of PCIS, therapy, and outcome were extracted and analyzed.
We identified 19 cases of PCIS in 4989 patients, yielding an incidence of 0.38%. The age of patients with PCIS ranged from 39 to 86 years. Dilated cardiomyopathy (DCM) as underlying cardiac disease and right atrial (RA) lead implantation had a significant association with occurrence of PCIS (p = 0.045 in DCM and p < 0.001 in RA lead implantation). Dyspnea, chest pain, dry cough, and fever were the most frequently reported symptoms in patients with PCIS. Pericardial and pleura effusion as well as elevated C‑reactive protein (CRP), increased erythrocyte sedimentation rate (ESR), and leukocytosis were the most common findings.
To the best of our knowledge, this is the largest cohort evaluating the incidence of PCIS after CIED implantation. The data show that PCIS is a rare complication after CIED implantation and occurs more frequently in patients with DCM and those with RA lead implantation. Although rare and mostly benign, PCIS can lead to potentially lethal complications and physicians must be aware of its symptoms.
心脏损伤后综合征（PCIS）是一种由心外膜、心肌或心内膜损伤引起的炎症性并发症。它发生于创伤、心肌梗死、经皮冠状动脉介入治疗、心脏手术、心内消融以及植入心脏植入式电子设备（CIED）之后。在本研究中，我们评估了CIED植入术后PCIS的发生率及其可能的危险因素。
对2000年至2014年间在海德堡大学医院接受CIED植入的所有患者（n = 4989例患者）进行评估。提取并分析临床数据，包括年龄、性别、基础心脏病、植入的CIED类型、电极植入位置、临床症状、PCIS症状发作时间、治疗及结局。
我们在4989例患者中识别出19例PCIS病例，发生率为0.38%。PCIS患者的年龄在39岁至86岁之间。扩张型心肌病（DCM）作为基础心脏病以及右心房（RA）导联植入与PCIS的发生有显著关联（DCM中p = 0.045，RA导联植入中p < 0.001）。呼吸困难、胸痛、干咳和发热是PCIS患者最常报告的症状。心包和胸腔积液以及C反应蛋白（CRP）升高、红细胞沉降率（ESR）加快和白细胞增多是最常见的表现。
据我们所知，这是评估CIED植入术后PCIS发生率的最大队列研究。数据表明，PCIS是CIED植入术后的一种罕见并发症，在DCM患者和RA导联植入患者中更常发生。尽管罕见且大多为良性，但PCIS可导致潜在致命并发症，医生必须了解其症状。
