Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
J Cardiovasc Electrophysiol. 2022 Aug;33(8):1847-1856. doi: 10.1111/jce.15613. Epub 2022 Jul 8.
The skin overlying cardiovascular implantable electronic devices (CIEDs) sometimes becomes very thin after implantations, which could cause a device erosion. The factors related to the skin thickness of device pockets have not been elucidated. This study aimed to evaluate the skin thickness of CIED pockets and search for the factors associated with the thickness.
Seventeen skin thickness points around the CIED pocket were measured through ultrasonography in each patient.
A total of 101 patients (76 ± 11 years, 26 female) were enrolled. The median duration from the implantation to the examination was 95 months (quartile: 52.5-147.5). The median skin thickness overlying the device was 4.1 mm (3.3-5.9). Patients with heart failure and malignancy had thinner skin overlying the CIED than those without. A significant correlation existed between skin thickness and body mass index (BMI), hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction. In contrast, age, gender, and device size did not exhibit a significant correlation with skin thickness. A multivariate logistic regression analysis revealed that chronic heart failure and a decrease in the eGFR and BMI were independent predictive factors of "very thin (≦3.3 mm)" skin of the CIED pocket late after an implantation.
Aside from a low BMI, the comorbidities (low hemoglobin, heart failure, and renal dysfunction) had a stronger impact on the skin thickness overlying the device than the device size. A careful observation of the device pocket should be performed in patients with those risk factors.
心血管植入式电子设备（CIED）的皮肤在植入后有时会变得非常薄，这可能导致设备侵蚀。与设备袋皮肤厚度相关的因素尚未阐明。本研究旨在评估 CIED 袋的皮肤厚度并寻找与厚度相关的因素。
通过超声在每位患者的 CIED 袋周围测量 17 个皮肤厚度点。
共纳入 101 例患者（76±11 岁，26 名女性）。从植入到检查的中位时间为 95 个月（四分位距：52.5-147.5）。设备上方的皮肤厚度中位数为 4.1mm（3.3-5.9）。患有心力衰竭和恶性肿瘤的患者比无心力衰竭和恶性肿瘤的患者的 CIED 皮肤更薄。皮肤厚度与体重指数（BMI）、血红蛋白、血清肌酐、估算肾小球滤过率（eGFR）和左心室射血分数之间存在显著相关性。相比之下，年龄、性别和设备尺寸与皮肤厚度无显著相关性。多变量逻辑回归分析显示，慢性心力衰竭以及 eGFR 和 BMI 的降低是植入后晚期“非常薄（≦3.3mm）”CIED 袋皮肤的独立预测因素。
除了 BMI 较低外，合并症（低血红蛋白、心力衰竭和肾功能障碍）对设备上方皮肤厚度的影响比设备尺寸更强。在有这些危险因素的患者中，应仔细观察设备袋。
