Wadhwani Lalit, Occhipinti Karen, Selim Ahmed, Manmadhan Arun, Kushnir Alexander, Barbhaiya Chirag, Jankelson Lior, Holmes Douglas, Bernstein Scott, Spinelli Michael, Knotts Robert, Park David S, Chinitz Larry A, Aizer Anthony
NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York.
NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York.
Heart Rhythm. 2021 Dec;18(12):2110-2114. doi: 10.1016/j.hrthm.2021.09.008. Epub 2021 Sep 10.
More than 3 million cardiovascular implantable electronic devices (CIEDs) are implanted annually. There are minimal data regarding the timing of diagnosis of acute complications after implantation. It remains unclear whether patients can be safely discharged less than 24 hours postimplantation.
The purpose of this study was to determine the precise timing of acute complication diagnosis after CIED implantation and optimal timing for same-day discharge.
A retrospective cohort analysis of adults 18 years or older who underwent CIED implantation at a large urban quaternary care medical center between June 1, 2015, and March 30, 2020, was performed. Standard of care included overnight observation and chest radiography 6 and 24 hours postprocedure. Medical records were reviewed for the timing of diagnosis of acute complications. Acute complications included pneumothorax, hemothorax, pericardial effusion, lead dislodgment, and implant site hematoma requiring surgical intervention.
A total of 2421 patients underwent implantation. Pericardial effusion or cardiac tamponade was diagnosed in 13 patients (0.53%), pneumothorax or hemothorax in 19 patients (0.78%), lead dislodgment in 11 patients (0.45%), and hematomas requiring surgical intervention in 5 patients (0.2%). Of the 48 acute complications, 43 (90%) occurred either within 6 hours or more than 24 hours after the procedure. Only 3 acute complications identified between 6 and 24 hours required intervention during the index hospitalization (0.12% of all cases).
Most acute complications are diagnosed either within the first 6 hours or more than 24 hours after implantation. With rare exception, patients can be considered for discharge after 6 hours of appropriate monitoring.
每年有超过300万例心血管植入式电子设备（CIED）被植入。关于植入后急性并发症的诊断时机，相关数据极少。目前尚不清楚患者在植入后不到24小时能否安全出院。
本研究的目的是确定CIED植入后急性并发症的精确诊断时机以及同日出院的最佳时机。
对2015年6月1日至2020年3月30日期间在一家大型城市四级医疗中心接受CIED植入的18岁及以上成年人进行回顾性队列分析。护理标准包括术后6小时和24小时进行过夜观察及胸部X线检查。查阅病历以确定急性并发症的诊断时间。急性并发症包括气胸、血胸、心包积液、导线移位以及需要手术干预的植入部位血肿。
共有2421例患者接受了植入。13例患者（0.53%）被诊断为心包积液或心脏压塞，19例患者（0.78%）诊断为气胸或血胸，11例患者（0.45%）诊断为导线移位，5例患者（0.2%）诊断为需要手术干预的血肿。在48例急性并发症中，43例（90%）发生在术后6小时内或24小时后。在6至24小时之间发现的仅3例急性并发症需要在首次住院期间进行干预（占所有病例的0.12%）。
大多数急性并发症在植入后的前6小时内或24小时后被诊断出来。除极少数情况外，经过6小时适当监测后，患者可考虑出院。
