Parameters associated with one-year mortality and in-hospital adverse events in patients after emergency pacemaker implantation

Abstract

A b s t r a c tBackground: Permanent cardiac pacing is the treatment of choice for severe and symptomatic bradycardia. Patients undergoing emergency pacemaker implantation are stabilised earlier by the insertion of a temporary emergency pacing lead, and they experience more comorbidities than with planned admissions. Aim:To identify the parameters associated with one-year mortality and in-hospital adverse events after emergency permanent pacemaker implantation. Methods:This retrospective study analyses data from 131 consecutive emergency pacemaker implantations performed within a single centre. Results:Cox regression analysis revealed the independent predictors of death to be: use of a temporary transvenous pacing lead (TTPL) (HR = 2.82, 95% CI 1.21-6.58, p = 0.02), age ≥ 78 years (OR = 3.01, 95% CI 1.22-7.42, p = 0.02), longer baseline QRS duration (HR = 1.02, 95% CI 1.00-1.03, p = 0.03), and history of myocardial infarction (MI) (HR = 2.43, 95% CI 1.04-5.68, p = 0.04). Twenty-six patients experienced in-hospital adverse events, such as: death (n = 6), cardiac arrest (n = 3), surgical complications (lead dislocation: n = 4, haematoma: n = 4, microperforation: n = 2), pneumonia or respiratory tract disease (n = 7), wound infection treated with antibiotics (n = 1), and subsequent MI following pacemaker implantation (n = 2). Multivariate logistic regression analysis showed that independent parameters associated with in-hospital adverse events were history of MI (OR = 5.01, 95% CI 1.88-13.3, p = 0.001) and stroke (OR = 3.51, 95% CI 1.16-10.55, p = 0.03). Conclusions:Our results suggest that the most serious risk factors of one-year mortality related to the use of TTPL are: age ≥ 78 years, longer baseline QRS duration, and history of MI. The independent parameters associated with in-hospital adverse events were the presence of a history of MI and stroke.

Ten-year study of late electrotherapy complications. Single-centre analysis of indications and safety of transvenous leads extraction

“…Non-infective causes for qualification for TLE were divided into classes in accordance with the HRS guidelines [1,3]. The presented classification distinguishes primary and lower-level indications.…”

“…The rise in the number of cardiac implantable electronic device (CIED) implantations: pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronisation therapy (CRT) devices, resulting from broader indications for implantation and a change in patient profile, is associated with an increased incidence of complications of electrotherapy [1][2][3][4][5]. Particularly important are the late complications, appearing a few, or even over a dozen years, after implantation, because it is difficult to predict the risk factors for their occurrence, as well as to establish a single mode of action.…”

A new medical diagnosis method based on Z-numbers

“…However, these methods above do not take into account fuzzy concept and uncertainties of medicine. In fact, due to the own characteristics of medicine [28,5,13], more fuzzy concept and more uncertainties, some mathematics methods, which have the ability to deal with the fuzzy and uncertain information, are needed for solving medical diagnosis problems. Recently, fuzzy mathematics [46] and Dempster-Shafer (DS) evidence theory [37,12,16,39] are widely applied in medical diagnosis, since they could reasonably model uncertainty and fuzzy information and describe them.…”