Value of radiography in diagnosing complications of cardioverter defibrillators implanted without thoracotomy in 437 patients.

Gupta, Akshay; Zegel, Harry G.; Dravid, Vikram S.; Nierenberg, S J; Freiman, DB

doi:10.2214/ajr.168.1.8976930

Cited by 24 publications

(5 citation statements)

References 5 publications

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“…In the DBS patient without hardware mobility, the typical radiographic appearance of the cable is that of 2 radio-opaque metal wires that travel side by side; when the IPG is rotated within the pocket, every rotation introduces a single turn within the cable, thus causing a double-helix (or braided) pattern similar to that used to illustrate deoxyribonucleic acid. The pattern of twisting in movement disorder patients is comparable to what is encountered in cardiac-pacemaker-related cases [14] . The connector can also twist along with the extension cable, transmitting the rotatory forces to the proximal part of the intracranial lead and causing it to coil or kink, as demonstrated in figure 2 .…”

Section: Discussionsupporting

confidence: 65%

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Burdick

Okun

Haq

et al. 2010

Stereotact Funct Neurosurg

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We reviewed our deep brain stimulation patient database to describe hardware complications which resulted from implantable pulse generator mobility, a phenomenon referred to as twiddler’s syndrome. A prospectively collected database of adverse events for all patients operated on at the University of Florida was queried searching for hardware malfunctions. Of 362 total leads implanted in 226 patients since 2002, there were 17 hardware malfunctions. Three of them were due to twiddler’s syndrome, representing 1.3% of patients (3 of 226 patients) and 1.4% of leads (5 of 362 leads). The subjects had characteristic presentations including re-emergence of symptoms, pain along the path of the hardware, abnormal impedances/current drain and radiographic signs of twisting/fracture. In all cases securing the implantable pulse generator within the chest pocket resolved the issue. Twiddler’s syndrome in the population of movement disorder patients treated with deep brain stimulation is an uncommon but important adverse event. It possesses a characteristic presentation and with appropriate diagnostic evaluation it is treatable and future occurrences are preventable.

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Section: Discussionsupporting

confidence: 65%

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Burdick

Okun

Haq

et al. 2010

Stereotact Funct Neurosurg

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“…Administrative data have many limitations when used to study a clinical intervention. Previous studies identified many cardiac device-related complications, such as pocket hematoma, 15 , 37 , 38 pocket infections, 7 , 38 – 43 iatrogenic pneumothorax, 40 , 41 arterial puncture, 40 venous thrombosis and stenosis, 41 electrode displacement, 40 lead dislodgements, undersensing, 40 , 42 cardiac device endocarditis, 44 , 45 interference by an electronic antitheft-surveillance device 46 or a Personal Digital Assistant, 17 and twiddle-induced torsion of leads. 41 Administrative data may not able to identify many of these specific types of complications.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Device Implantation in the United States from 1997 through 2004: A Population-based Analysis

et al. 2007

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OBJECTIVE Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS We screened hospital discharge abstracts from the 1997–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume–outcome relationship across different outcome measures and patient groups. CONCLUSIONS The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.

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“…31 Routine radiological surveillance is low yield. 32 Newer systems perform daily automatic measurements of lead impedance and can warn patients with an alarm tone if the measurement is out of range ( Fig. 1).…”

Section: Limitations Of Icds As Pacemakers Long-term Lead Reliabilitymentioning

confidence: 99%

Permanent Pacing via Implantable Defibrillators

Pinski

Trohman

2000

Pacing Clinical Electrophis

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Value of radiography in diagnosing complications of cardioverter defibrillators implanted without thoracotomy in 437 patients.

Cited by 24 publications

References 5 publications

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Prevalence of Twiddler’s Syndrome as a Cause of Deep Brain Stimulation Hardware Failure

Cardiac Device Implantation in the United States from 1997 through 2004: A Population-based Analysis

Permanent Pacing via Implantable Defibrillators

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