Repeat implantable cardioverter defibrillator (ICD) procedures are increasing and
may be associated with higher risks for complications. To provide more information
for clinical decision making, especially in light of recent defibrillator advisories,
we examined a large national cohort to characterize repeat ICD procedural outcomes.
Using data from the National Cardiovascular Data Registry (ICD Registry), we compared
patient characteristics, reasons for ICD implantation, and associated in-hospital
adverse events among 92,751 patients receiving their first device and 81,748 patients
who underwent repeat procedures with (n = 31,057) and without (n = 50,691) lead involvement.
Hierarchical multivariable logistic regression was used to determine the predictors
of in-hospital complications. Complication rates were higher in those who underwent
repeat ICD procedures with lead involvement (lead implantation or revision), compared
with patients who underwent initial implants (3.2% vs 2.6%, p <0.001) or versus those
with pocket-only (e.g., generator change only) procedures (3.2% vs 0.6%, p <0.001).
There were significantly more in-hospital deaths, lead dislodgements, and infections
requiring antibiotics in the lead involvement cohort. Compared with those who had
a pocket-only procedure, the multivariable adjusted odds ratio of any complication
were increased at 4.20 (95% confidence interval: 3.66 to 4.82, p <0.001) in patients
who underwent repeat procedures with lead involvement excluding lead extraction or
7.11 (95% confidence interval: 5.96 to 8.48, p <0.001) in procedures involving lead
extractions. In conclusion, repeat ICD procedures, when involving the addition or
revision of a lead with or without concurrent lead extraction, are associated with
higher complication rates compared with initial implants and with those who underwent
pocket-only procedures.
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Article Info
Publication History
Published online: May 16, 2014
Accepted:
May 1,
2014
Received in revised form:
May 1,
2014
Received:
January 31,
2014
Footnotes
This research was supported by the American College of Cardiology Foundation's NCDR . The views expressed in this article represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com. The ICD Registry is an initiative of the American College of Cardiology Foundation and Heart Rhythm Society. This article was approved with only minor editorial changes by the ICD Registry Research and Publications Committee before manuscript submission.
See page 425 for disclosure information.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
