Wound haematoma following defibrillator implantation: incidence and predictors in the Shockless Implant Evaluation (SIMPLE) trial
Por:
Masiero, S, Connolly, SJ, Birnie, D, Neuzner, J, Hohnloser, SH, Vinolas, X, Kautzner, J, O'Hara, G, VanErven, L, Gadler, F, Wang, J, Mabo, P, Glikson, M, Kutyifa, V, Wright, DJ, Essebag, V, Healey, JS
Publicada:
1 jun 2017
Resumen:
Aims Pocket haematoma is a common complication after defibrillator [implantable cardioverter defibrillator (ICD)] implantation, which is not only painful, but also increases the risk of device-related infection, and possibly embolic events. The present study seeks to evaluate the rate and predictors of clinically significant pocket haematoma.
Methods and results This study included 2500 patients receiving an ICD in the SIMPLE trial. A clinically significant pocket haematoma was defined as a haematoma that required re-operation or interruption of oral anticoagulation (OAC) therapy. Clinically significant pocket haematoma occurred in 56 of 2500 patients (2.2%) of which 6 (10.7%) developed device-related infection. Patients who developed pocket haematoma were older (mean age 67.6 +/- 8.8 years vs. 62.7 +/- 11.6 years, P < 0.001), were more likely to have permanent atrial fibrillation (30.4 vs. 6.7%, P < 0.001) and a history of stroke (17.9 vs. 6.7%, P = 0.004), or were more likely to receive peri-operative OAC (50.0 vs. 28.4%, P < 0.001), unfractionated heparin (16.1 vs. 5.2%, P = 0.003), or low-molecular-weight heparin (37.5 vs. 17.5%, P < 0.001). Independent predictors of wound haematoma on multivariable analysis included the use of heparin bridging (OR 2.65, 95% CI 1.48-4.73, P = 0.001), sub-pectoral location of ICD (OR 2.00, 95% CI 1.12-3.57, P = 0.020), previous stroke (OR 2.47, 95% CI 1.20-5.10, P = 0.015), an upgrade from permanent pacemaker (OR 2.52, 95% CI 1.07-5.94, P = 0.035), and older age (OR 1.03, 95% CI 1.00-1.06, P = 0.049).
Conclusion Pocket haematoma remains an important complication of ICD implantation and is associated with a high risk of infection. Independent predictors of pocket haematoma include heparin bridging, prior stroke, sub-pectoral placement of ICD, older age, and upgrade from a pacemaker.
Filiaciones:
Masiero, S:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Univ Politecn Marche, Clin Cardiol, Via Conca 71, I-60126 Ancona, Italy
Connolly, SJ:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Birnie, D:
Univ Ottawa, Heart Inst, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
Neuzner, J:
Klinikum Kassel, 43,Monchebergstr 41, D-34125 Kassel, Germany
Hohnloser, SH:
Goethe Univ Frankfurt, Theodor W Adorno Pl 6, D-60323 Frankfurt, Germany
Vinolas, X:
Hosp Santa Creu & Sant Pau, Carrer St Quinti 89, Barcelona 08026, Spain
Kautzner, J:
Inst Clin & Expt Med, Videnska 1958-9, Prague 14021 4, Krc, Czech Republic
O'Hara, G:
Inst Univ Cardiol & Pneumol Quebec, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
VanErven, L:
Leiden Univ, Med Ctr, Albinusdreef 2, NL-2333 ZA Leiden, Netherlands
Gadler, F:
Karolinska Inst, Solnavagen 1, S-17177 Stockholm, Sweden
Wang, J:
McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
Mabo, P:
Ctr Hosp Univ, 2 Rue Henri le Guilloux, F-35000 Rennes, France
Glikson, M:
Chaim Sheba Med Ctr, Leviev Heart Ctr, IL-52621 Tel Aviv, Israel
Kutyifa, V:
Univ Rochester, Med Ctr, 601 Elmwood Ave, Rochester, NY 14642 USA
Wright, DJ:
Liverpool Heart & Chest Hosp, Inst Cardiovasc Med & Sci, Thomas Dr, Liverpool L14 3PE, Merseyside, England
Essebag, V:
McGill Univ, 845 Rue Sherbrooke O, Montreal, PQ H3A 0G4, Canada
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