Mortality and Cerebrovascular Events Following Heart Rhythm Disorder Management Procedures
Background—Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular event (CVE) after heart rhythm disorder management (HRDM) procedures is an essential step for development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and characterize death and CVE (stroke or transient ischemic attack) after HRDM procedures over a 17-year period.
Methods—We performed a retrospective cohort study of all patients undergoing HRDM procedures between January 2000 and November 2016 at the Mayo Clinic. Patients from all three tertiary academic centers (Rochester, Phoenix and Jacksonville) were included in the study. All cases of in-hospital death and CVE after HRDM procedures were identified and were further characterized as directly or indirectly related to the HRDM procedure. Subgroup analysis of death and CVE rates was performed for ablation, device implantation, EP study, lead extraction, and defibrillation threshold testing procedures.
Results—A total of 48,913 patients (65.7±6.6 years, 64% male) who underwent a total of 62,065 HRDM procedures were included in the study. The overall mortality and CVE rate in the cohort was 0.36% (95% CI=0.31-0.42) and 0.12% (95% CI=0.09-0.16) respectively. Patients undergoing lead extraction had the highest overall mortality rate at 1.9% (95% CI=1.34-2.61) and CVE rate at 0.62% (95% CI=0.32-1.07). Among patients undergoing HRDM procedures, 48% of deaths directly related to the HDRM procedure were among patients undergoing device implantation procedures. Overall, cardiac tamponade was the most frequent direct cause of death (40%), and infection was the most common indirect cause of death (29%). The overall 30-day mortality rate was 0.76%, with the highest being in lead extraction procedures (3.08%), followed by device implantation procedures (0.94%).
Conclusions—Half of the deaths directly related to a HRDM procedure were among the patients undergoing device implantation procedures, with cardiac tamponade being the most common cause of death. This highlights the importance of development of protocols for quick identification and management of cardiac tamponade even in procedures typically believed to be lower risk such as device implantation.
- Received July 13, 2017.
- Revision received September 12, 2017.
- Accepted September 27, 2017.