Remoção percutânea de eletrodos de estimulação cardíaca artificial: taxa de sucesso e de complicação em uma série de 61 pacientes consecutivos
Remoção percutânea de eletrodos de estimulação cardíaca artificial: taxa de sucesso e de complicação em uma série de 61 pacientes consecutivos
Data
2018
Autores
Di Nubila, Bruna Costa Lemos Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Fundamento. Nas últimas décadas, o número de dispositivos eletrônicos
cardíacos implantáveis (DECI) aumentou consideravelmente, assim como a
necessidade de remoção destes. Neste contexto, a remoção percutânea
apresenta-se como uma técnica segura e capaz de evitar uma cirurgia cardíaca
convencional.
Objetivos. Primário: Descrever a taxa de sucesso e complicações da remoção
percutânea de DECI em um hospital público brasileiro. Secundário: Estabelecer
fatores associados ao sucesso e complicações.
Métodos. Serie de casos retrospectiva de todos pacientes submetidos a
remoção de DECI em um hospital público brasileiro no período de janeiro/2012
a junho/2018. Remoção, explante, extração de eletrodos foram definidos
conforme a última diretriz norte-americana. As definições desta diretriz também
foram seguidas para definir as complicações e desfechos do procedimento.
Variáveis categóricas foram comparadas pelos testes Qui-quadrado/Exato de
Fisher, enquanto variáveis continuas por testes não pareados de Student/Mann-
Whitney. O p-valor de 0,05 foi considerado estatisticamente significativo.
Resultados. 61 pacientes foram submetidos a remoção de DECI, sendo 51
extrações e 10 explantes. No total 128 eletrodos foram removidos. Taxa de
sucesso clínico foi 100% no grupo do explante e 90,2% no da extração(p=0,58).
Complicações maiores foram encontradas em 7,8% dos pacientes submetidos à
extração, enquanto que no grupo do explante não foram encontradas(p=1,0).
Falha do procedimento foi associada a eletrodos de ventrículo(p=0,05) e
átrio(p=0,04) direito mais antigos e a menor tempo de internação após o
procedimento(p=0,027). Duração do procedimento(p=0,003) foi associado a
maior índice de complicação.
Conclusão. A remoção percutânea é um procedimento seguro, com taxa de
sucesso de 91,8% e complicações maiores de 6,6%. Remoções de eletrodos de
atriais e ventriculares mais antigos e menor tempo de internação após o
procedimento estiveram associados a menores taxa de sucesso. Enquanto que
complicações estiveram associada a procedimentos mais longos e a presença
de transfusão sanguínea.
Background. In the last decades, the number of cardiac electronic devices have risen considerably and consequently, this have led to more device removal. Transvenous lead removal appears in this situation as a safe procedure that can avoid an open-heart surgery. Aim. The primary objective of this study was to describe the success and complication rates of pacemaker removal in a Brazilian public hospital. Our secondary aim was to describe which variables were associated to success and complications. Methods. We performed a retrospective case series in patients submitted to a pacemaker removal in a Brazilian public hospital from January 2012 to June 2018. Removal, explant and extraction definitions were based on the last Heart Rhythm Society Guideline. Definition of success and complication also followed this guideline. Categorical variables were compared using x2 or Fisher’s tests, while continuous variables by unpaired tests of Student/Mann-Whitney. A P-value of 0.05 was considered statistically significant. Results. A cardiac device removal was performed in 61 patients in which 51 were submitted to lead extraction and 10 to lead explant. In total, 128 leads were removed. Our clinical success was 100% in the explant group and 90.2% in the extraction one(p=0.58). Major complications were present in 7.8% patients submitted to extraction, but they were not presented in the explant group(p=1.0). Procedure failure was associated to older right ventricular(p=0.05) and atrial(p=0.04) leads and to shorter hospital stay after the procedure(p=0.027). Procedure duration(p=0.003) was associated to more complications. Conclusion. Percutaneous lead removal is a safe procedure with success rate of 91.8% and major complications of 6.6%. Older ventricle and atrial leads and shorter in hospital stay were associated to lower success, whereas transfusion and longer procedures were associated to complications.
Background. In the last decades, the number of cardiac electronic devices have risen considerably and consequently, this have led to more device removal. Transvenous lead removal appears in this situation as a safe procedure that can avoid an open-heart surgery. Aim. The primary objective of this study was to describe the success and complication rates of pacemaker removal in a Brazilian public hospital. Our secondary aim was to describe which variables were associated to success and complications. Methods. We performed a retrospective case series in patients submitted to a pacemaker removal in a Brazilian public hospital from January 2012 to June 2018. Removal, explant and extraction definitions were based on the last Heart Rhythm Society Guideline. Definition of success and complication also followed this guideline. Categorical variables were compared using x2 or Fisher’s tests, while continuous variables by unpaired tests of Student/Mann-Whitney. A P-value of 0.05 was considered statistically significant. Results. A cardiac device removal was performed in 61 patients in which 51 were submitted to lead extraction and 10 to lead explant. In total, 128 leads were removed. Our clinical success was 100% in the explant group and 90.2% in the extraction one(p=0.58). Major complications were present in 7.8% patients submitted to extraction, but they were not presented in the explant group(p=1.0). Procedure failure was associated to older right ventricular(p=0.05) and atrial(p=0.04) leads and to shorter hospital stay after the procedure(p=0.027). Procedure duration(p=0.003) was associated to more complications. Conclusion. Percutaneous lead removal is a safe procedure with success rate of 91.8% and major complications of 6.6%. Older ventricle and atrial leads and shorter in hospital stay were associated to lower success, whereas transfusion and longer procedures were associated to complications.
Background. In the last decades, the number of cardiac electronic devices have risen considerably and consequently, this have led to more device removal. Transvenous lead removal appears in this situation as a safe procedure that can avoid an open-heart surgery. Aim. The primary objective of this study was to describe the success and complication rates of pacemaker removal in a Brazilian public hospital. Our secondary aim was to describe which variables were associated to success and complications. Methods. We performed a retrospective case series in patients submitted to a pacemaker removal in a Brazilian public hospital from January 2012 to June 2018. Removal, explant and extraction definitions were based on the last Heart Rhythm Society Guideline. Definition of success and complication also followed this guideline. Categorical variables were compared using x2 or Fisher’s tests, while continuous variables by unpaired tests of Student/Mann-Whitney. A P-value of 0.05 was considered statistically significant. Results. A cardiac device removal was performed in 61 patients in which 51 were submitted to lead extraction and 10 to lead explant. In total, 128 leads were removed. Our clinical success was 100% in the explant group and 90.2% in the extraction one(p=0.58). Major complications were present in 7.8% patients submitted to extraction, but they were not presented in the explant group(p=1.0). Procedure failure was associated to older right ventricular(p=0.05) and atrial(p=0.04) leads and to shorter hospital stay after the procedure(p=0.027). Procedure duration(p=0.003) was associated to more complications. Conclusion. Percutaneous lead removal is a safe procedure with success rate of 91.8% and major complications of 6.6%. Older ventricle and atrial leads and shorter in hospital stay were associated to lower success, whereas transfusion and longer procedures were associated to complications.
Background. In the last decades, the number of cardiac electronic devices have risen considerably and consequently, this have led to more device removal. Transvenous lead removal appears in this situation as a safe procedure that can avoid an open-heart surgery. Aim. The primary objective of this study was to describe the success and complication rates of pacemaker removal in a Brazilian public hospital. Our secondary aim was to describe which variables were associated to success and complications. Methods. We performed a retrospective case series in patients submitted to a pacemaker removal in a Brazilian public hospital from January 2012 to June 2018. Removal, explant and extraction definitions were based on the last Heart Rhythm Society Guideline. Definition of success and complication also followed this guideline. Categorical variables were compared using x2 or Fisher’s tests, while continuous variables by unpaired tests of Student/Mann-Whitney. A P-value of 0.05 was considered statistically significant. Results. A cardiac device removal was performed in 61 patients in which 51 were submitted to lead extraction and 10 to lead explant. In total, 128 leads were removed. Our clinical success was 100% in the explant group and 90.2% in the extraction one(p=0.58). Major complications were present in 7.8% patients submitted to extraction, but they were not presented in the explant group(p=1.0). Procedure failure was associated to older right ventricular(p=0.05) and atrial(p=0.04) leads and to shorter hospital stay after the procedure(p=0.027). Procedure duration(p=0.003) was associated to more complications. Conclusion. Percutaneous lead removal is a safe procedure with success rate of 91.8% and major complications of 6.6%. Older ventricle and atrial leads and shorter in hospital stay were associated to lower success, whereas transfusion and longer procedures were associated to complications.
Description
Palavras-chave
Marcapasso artificial, Ressincronizador cardíaco, Eletrodos implantáveis, Pacemaker, artificial, Electrodes, Implanted, Cardiac resynchronization therapy devices
Citação
Di Nubila. Remoção percutânea de eletrodos de estimulação cardíaca artificial: Taxa de sucesso e de complicação em uma série de 61 pacientes consecutivos. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]; 2018.