Abstract 19572: Obese Female Patients Have Higher Rates of Lead Dislodgement After ICD or CRT-D Implantation
Background: While there is significant data available regarding the effects of gender and obesity in cardiovascular disease, research focusing on defibrillators has been limited. Obese patients (pts) are considered at higher risk for complications of cardiac implantable electronic devices (CIED). However, no study has been published regarding the relationship between gender, obesity and risk of CIEDs implantation. The aim of this study was to evaluate complications of defibrillator implantation (ICD and CRT-D) and their rationship to gender and body mass index (BMI).
Methods: We analyzed all complications related to ICD or CRT-D implantation from 2005 to 2012 at University of California San Diego Health System. Only ICD or CRT-D implants with a new lead were included in the analysis. Four hundred twenty nine consecutive pts were included. We divided these 429 pts into 4 groups based on gender and BMI (Group1=Male, BMI≥30, Group 2=Male, BMI<30, Group 3=Female, BMI≥30, Group 4=Female, BMI<30) and compared rate of complications among these 4 groups.
Results: During 26.8±23.7 months follow-up, complications were observed in 75 patients (17.5 %). Lead dislodgement (32 patients), diaphragmatic pacing (9 patients), pocket hematoma or bleeding (8 patients), infection (8 patients) and pneumothorax (6 patients) accounted for >80% of all complications. Fifty-four of these 75 pts needed additional surgical procedures or eariler generator exchange. No significant differences were observed in overall complication rates among the 4 groups (15.6%, 16.1%, 24.6% and 31.3%). However, lead dislodgement occurred at a significantly higher rate (p<0.001) in group 4 (27.5%) compared to the other groups (5.7%, 6.7% and 7.7%).
Conclusions: In our retrospective, single-center study there was a higher risk of lead dislodgement in obese female pts undergoing ICD or CRT-D implantation. Careful attention to lead and device anchoring, particularly with larger cardiac devices, may be more important in this group of pts to avoid lead dislodgement.
- © 2012 by American Heart Association, Inc.