Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America.
Office of Information Technology, University of Tennessee, Knoxville, TN, United States of America.
PLoS One. 2023 Nov 28;18(11):e0290029. doi: 10.1371/journal.pone.0290029. eCollection 2023.
The aim of this retrospective cohort study was to provide a single-center clinical audit of complications for single chamber permanent pacemaker implantation (PPI) techniques and determine if the clinical parameters, PPI technique or complications were associated with outcome. The electronic medical records were searched for dogs treated for bradyarrhythmia with PPI. Data related to presenting complaint, signalment of the dog, ECG diagnosis, echocardiographic findings, PPI technique, and programing of the pacemaker were recorded. Survival length (days) was recorded as the last veterinary visit; if the dog was dead the reason was documented. Cumulative survival of each pacemaker was examined by a Kaplan-Meier survival curve and the two techniques compared with a logrank test. Chi-square was used to determine the association between major complications and death. A total of 66 dogs with 52 transvenous and 30 epicardial PPIs were included. All epicardial pacemakers were implanted via transdiaphragmatic approach. A total of 31 life-threatening complications were reported. There were nine deaths related to major complications (13.6% of the study sample). The median follow-up period was 366 days, with a median survival of 255 days, and a significant difference in cumulative survival of each pacemaker (P = 0.01) between epicardial (93 days, range 0-1882 days) and transvenous (334 days, range 0-2745) PPIs but no significant difference in cumulative survival between the two techniques when only the first pacemaker was considered (p = 0.07). The presence of a major complications had a significant association with death due to pacemaker complications (P<0.001). The decision to perform epicardial PPI in failed transvenous PPI patients may have skewed the cumulative survival as was evident in the lack of significant difference in survival when only first PPI were examined. Major complication rates between the two techniques were similar and the authors consider both techniques equally reliable to manage symptomatic bradycardia in dogs.
这项回顾性队列研究的目的是提供单腔永久性起搏器植入（PPI）技术的单中心临床审核，并确定临床参数、PPI 技术或并发症是否与结果相关。搜索了接受 PPI 治疗心动过缓的狗的电子病历。记录了与就诊主诉、狗的品种、心电图诊断、超声心动图发现、PPI 技术和起搏器程控相关的数据。生存时间（天）记录为最后一次兽医就诊；如果狗死亡，则记录原因。通过 Kaplan-Meier 生存曲线检查每个起搏器的累积生存率，并通过对数秩检验比较两种技术。卡方检验用于确定主要并发症与死亡之间的关系。共纳入 66 只狗，其中 52 只经静脉 PPI 和 30 只心外膜 PPI。所有心外膜起搏器均通过经膈肌入路植入。报告了 31 例危及生命的并发症。有 9 例死亡与严重并发症有关（研究样本的 13.6%）。中位随访时间为 366 天，中位生存时间为 255 天，两种起搏器的累积生存率有显著差异（P = 0.01），心外膜（93 天，范围 0-1882 天）和经静脉（334 天，范围 0-2745 天）PPI，但仅考虑第一个起搏器时，两种技术的累积生存率无显著差异（P = 0.07）。主要并发症的存在与起搏器并发症导致的死亡有显著相关性（P<0.001）。在经静脉 PPI 失败的患者中进行心外膜 PPI 的决定可能会影响累积生存率，因为仅检查第一个 PPI 时，生存率没有显著差异。两种技术的主要并发症发生率相似，作者认为两种技术在治疗狗的症状性心动过缓时同样可靠。
