Khan Muhammad Zia, Sattar Yasar, Alruwaili Waleed, Nassar Sameh, Alhajji Mohamed, Alyami Bandar, Nguyen Amanda T, Neely Joseph, Abideen Asad Zain Ul, Agarwal Siddharth, Raina Sameer, Balla Sudarshan, Nguyen Bao, Fan Dali, Darden Douglas, Munir Muhammad Bilal
Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California.
Heart Rhythm O2. 2024 Feb 19;5(4):217-223. doi: 10.1016/j.hroo.2024.02.004. eCollection 2024 Apr.
Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation.
The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations.
The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed.
Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation.
In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.
需要经皮或手术干预的心包积液仍然是无导线起搏器植入的一个重要并发症。
本研究旨在确定无导线起搏器植入中需要干预的心包积液的真实世界患病率、危险因素及相关结局。
利用国家住院患者样本和国际疾病分类第十版编码，识别2016年至2020年期间接受无导线起搏器植入的患者。我们研究中评估的结局包括需要干预的心包积液的患病率、其他手术并发症及住院结局。还分析了心包积液的预测因素。
总共325例（1.1%）无导线起搏器植入发生了需要干预的心包积液。预测严重心包积液发生的患者层面特征包括年龄>75岁（比值比[OR]1.38，95%置信区间[CI]1.08 - 1.75）、女性（OR 2.03，95% CI 1.62 - 2.55）、凝血病（OR 1.50，95% CI 1.12 - 1.99）、慢性肺病（OR 1.36，95% CI 1.07 - 1.74）、慢性肾病（OR 1.53，95% CI 1.22 - 1.94）以及结缔组织疾病（OR 2.98,95% CI 2.02 - 4.39）。需要干预的心包积液与无导线起搏器植入后的死亡率（OR 5.66，95% CI 4.24 - 7.56）、住院时间延长（OR 1.36，95% CI 1.07 - 1.73）以及住院费用增加（OR 2.49，95% CI 1.92 - 3.21）独立相关。
在美国一个大型、当代、真实世界的无导线起搏器植入队列中，需要干预的心包积液患病率为1.1%。某些重要的患者层面特征预测了显著心包积液的发生，且此类积液与无导线起搏器植入后的不良结局相关。
