Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

Nazarian, Saman; Reynolds, Matthew R.; Ryan, Michael P.; Wolff, Steven; Mollenkopf, Sarah; Turakhia, Mintu P.

doi:10.1002/jmri.24971

Cited by 55 publications

(29 citation statements)

References 26 publications

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“…A monthly enrollment indicator is used to determine when a patient is followed up in MarketScan. Health outcomes research using MarketScan data has been widely published in peer‐reviewed journals, including studies of patients undergoing cardiac procedures and receiving implantable electronic devices 10, 11, 12. This study was a retrospective analysis of a deidentified database and, thus, the research was exempt from institutional review board review under 45 CFR 46.101(b)(4).…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal

Musat

Hoskins

et al. 2017

JAHA

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BackgroundPatients with atrial fibrillation (AF) often undergo AV junction ablation (AVJA) and pacemaker implantation. Right ventricular (RV) pacing contributes to increased risk of heart failure (HF), which may be mitigated by biventricular pacing. We sought to determine the impact of AVJA concurrent with RV versus biventricular pacemaker implantation on AF and HF hospitalizations.Methods and ResultsThe MarketScan Commercial and Medicare Supplemental claims database was used to select 18‐ to 100‐year‐old patients with AF with pacemaker implantation. Patients were divided into those with an RV and a biventricular pacemaker and further into those who did (AVJA +) or did not undergo concurrent ablation. Separately, the AVJA+ group was divided into those receiving RV versus biventricular pacemakers. AF and HF hospitalization rates were compared between groups after matching on demographics, comorbidities, and baseline hospitalization rates. The study included 24 361 patients, with RV (n=23 377) or biventricular (n=984) pacemakers; 1611 patients underwent AVJA. AVJA + was associated with reduced AF hospitalization risk (RV hazard ratio [HR], 0.31; P<0.001; biventricular HR, 0.20; P=0.003) compared with no AVJA. However, HF hospitalization risk was increased for RV (HR, 1.63; P=0.001), but not biventricular (HR, 0.98; P=0.942), pacemakers. In AVJA + patients, biventricular pacing was associated with reduced risk of HF hospitalization versus RV pacing (HR, 0.62; P=0.017).ConclusionsIn a large cohort of patients with AF, AVJA + significantly reduced AF hospitalizations, irrespective of whether an RV or a biventricular pacemaker was implanted. However, AVJA was associated with a marked HF hospitalization increase in patients with an RV pacemaker, which was ameliorated with biventricular pacing.

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Section: Methodsmentioning

confidence: 99%

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal

Musat

Hoskins

et al. 2017

JAHA

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“…The nationally representative databases include records from >170 million enrollees since 1995 13 and have supported publications on outcomes of patients undergoing cardiac procedures and implantable electronic devices. [14][15][16] This study was a retrospective analysis of a deidentified database and, thus, was exempt from Institutional Review Board review under 45 CFR 46.101(b) (4).…”

Section: Merchant Et Al Right Ventricular Pacing and Heart Failurementioning

confidence: 99%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results-A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB.Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions-Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. Study PopulationPatients were selected for study inclusion if they were implanted with a de novo dual-chamber pacemaker (Current Procedural Terminology code 33208 and Healthcare Common Procedure Coding System codes C1785 and C2619) from any manufacturer between April 1, 2008, and March 31, 2014. Patients with a left ventricular lead placed (Current Procedural Terminology codes 33224 or 33225) at the time of pacemaker implantation were excluded. De novo implants were identified as pacemaker patients without a previous device implantation and without a remote or in-office pacemaker follow-up visit in the 1 year before implantation. An enrollment indicator confirmed active inclusion in the MarketScan databases for each patient per month. Patients were required to have at least 1 year of continuous enrollment in the MarketScan database before and after pacemaker implantation and to be ≥18 and ≤100 years of age at the time of pacemaker implantation.To evaluate the impact of atrioventricular block (AVB) on the development of HF after pacemaker implantation, patients wi...

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“…1 Small studies have reported on the safety of MRI in patients who have a pacemaker or ICD 2–20 ; a recent larger study evaluated only nonthoracic examinations. 21 Other studies have specifically investigated the safety of MRI in patients who have pacemakers that, according to the Food and Drug Administration (FDA), have been shown to pose no known hazard under certain specified conditions of use; such devices are termed “MRI-conditional.” 22–25 However, the vast majority of pacemaker and ICD systems in current use are not labeled specifically as MRI-conditional and are termed “legacy” systems.…”

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confidence: 99%

Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices

et al. 2017

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BACKGROUND Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed “MRI-conditional” devices). METHODS We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter–defibrillator (42%) that was not considered to be MRI-conditional (termed a “legacy” device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters). RESULTS No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient’s device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming. CONCLUSIONS We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter– defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896.)

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Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

Cited by 55 publications

References 26 publications

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices

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