Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Koh, Youlin; Bingham, Nicholas; Law, Natalie; Le, Dustin; Mariani, Justin A.

doi:10.1111/pace.13106

Cited by 4 publications

(12 citation statements)

References 35 publications

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“…The incidence of CSH was 2.5%. This is consistent with recent studies reporting an incidence ranging from 1.2%–7.3% 1–7 . Importantly, different definitions of CSH among older studies make comparisons difficult.…”

Section: Discussionsupporting

confidence: 90%

“…A meta‐analysis by Bernard et al reports a five‐fold increased risk of bleeding complications (OR 5.0), 24 while a meta‐analysis by Yang et al reports an almost seven‐fold increase (OR 6.84) 16 . Several other studies support these findings 3,4,19,26,29–31 . Expert consensus statements suggest short preoperative pausing of clopidogrel while taken the indication for DAPT therapy into consideration 32 …”

Section: Discussionmentioning

confidence: 99%

“…We cannot rule out influence of confounders not included in the adjusted analysis. Previous studies have found venous access, 25 coagulopathy, 8,31 structural heart disease, 8,16 and chronic kidney disease 3,5 to influence the risk of hematoma. Importantly, our analysis included only pre‐specified variables, and we included a large, consecutive, nationwide cohort of CIED patients.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with recent studies reporting an incidence ranging from 1.2%–7.3%. 1 , 2 , 3 , 4 , 5 , 6 , 7 Importantly, different definitions of CSH among older studies make comparisons difficult. The risk of re‐operation due to CSH was very low (0.2%), likely a result of strict conservative treatment strategy whenever possible.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study

Fensman

Grove

Johansen

et al. 2022

Journal of Arrhythmia

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Purpose Clinically significant pocket hematoma (CSH) is a common complication to cardiac implantable electronic device (CIED) surgery. We aimed to evaluate predictors of CSH after CIED surgery. Methods We performed a nationwide population‐based prospective cohort study with systematic patient chart review of all Danish patients undergoing CIED surgery during a 12‐month period. Multiple logistic regression analysis was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for association between predictors and CSH. Results We included 5918 consecutive patients, 63% males, mean age 72.6 years. A total of 148 (2.5%) patients experienced CSH, including 10 patients (0.2%) requiring re‐operation with hematoma evacuation. The risk of CSH was significantly increased in patients treated with aspirin (aOR 1.8; 1.2–2.7), aspirin and clopidogrel (aOR 3.9; 2.3–6.5), or heparin (aOR 2.1; 1.1–4.1), and in patients with INR≥2.0 (aOR 2.0; 1.2–3.2). Patients operated by low‐volume operators (aOR 2.7; 1.6–4.6) or undergoing more complex CIED surgery such as cardiac resynchronization therapy (aOR 2.0; 1.1–3.5) or dual‐chamber defibrillator (aOR 2.1; 1.2–3.8) also had significantly increased CSH risk. Conclusion In a large nationwide cohort of consecutive patients undergoing CIED surgery, the risk of CSH was 2.5%, with 0.2% necessitating evacuation. CSH risk was increased both in patients receiving aspirin, dual antiplatelet therapy or continued vitamin K‐antagonist therapy. Dual antiplatelet therapy had the highest risk (aOR) of CSH. Both low operator volume and more complex CIED surgery were independently associated with higher CSH risk. These data should be considered when planning CIED surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study

Fensman

Grove

Johansen

et al. 2022

Journal of Arrhythmia

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“…Pneumothorax and hematothorax as major complications are rather infrequent, the incidence is described in 0.1–1.3% [ 1 , 4 ]. Bleeding at the puncture pocket site as minor complication occurs in up to 2% [ 10 , 11 ]. Most of the pocket hematomas are related to pocket formation rather than back from the venous system.…”

Section: Discussionmentioning

confidence: 99%

Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture

Keyser

Schopka

Jungbauer

et al. 2018

J Cardiothorac Surg

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BackgroundIn cases of lead failure after implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD) early lead replacement may be challenging. Puncture of the subclavian vein bears possible complications such as pneumothorax, hematothorax, and damage of leads to be left in place. To avoid venous puncture PM or ICD leads were replaced using a flexible polypropylene sheath (Byrd-sheath).MethodFrom January 2010 through December 2017, 55 patients underwent early lead exchange avoiding venous puncture. Early lead exchange for this study was defined as a reintervention within 14 days after the initial lead implantation. The connector of the malfunctioning lead was cut off, and stabilized by a stiff stylet. After having cut off the plastic knob of the stylet, the lead was passed through the polypropylene sheath and the latter advanced into the subclavian vein with gentle rotational movements to gain access to the subclavian vein. After lead removal the polypropylene sheath was replaced by a peel away sheath a new lead inserted.ResultsOverall, 23 defibrillation leads and 34 pacing leads (16 right atrial leads, 17 right ventricular leads, and 1 left ventricular lead) were successfully explanted. Access to the subclavian vein was uneventful, and blood loss minimal. Radiation exposure and fluoroscopy time were also negligible.ConclusionThe Byrd-sheath technique proved to be safe and successful in providing vein access within 2 weeks after initial lead implantation using the previously implanted lead and thus avoiding puncture of the subclavian vein.

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Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

Diemberger

Boriani

Deharo

2020

Infections of Cardiac Implantable Devices

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Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Abstract: Heparin and dual antiplatelet use remain strong predictors of overall hematoma formation. CKD is a comparatively moderate predictor. BMI > 25 may decrease the risk of hematoma formation. PPB had nonsignificant effects on hematoma development.

Cited by 4 publications

References 35 publications

Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study

Predictors of pocket hematoma after cardiac implantable electronic device surgery: A nationwide cohort study

Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture

Prevention of Device Infection: Procedural Aspects, Drugs, and Preventive Tools

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