Simona Masiero1,2, Stuart J Connolly3, David Birnie4, Jörg Neuzner5, Stefan H Hohnloser6, Xavier Vinolas7, Josef Kautzner8, Gilles O'Hara9, Lieselot VanErven10, Fredrik Gadler11, Jia Wang3, Philippe Mabo12, Michael Glikson13, Valentina Kutyifa14, David J Wright15, Vidal Essebag16, Jeff S Healey3. 1. Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. 2. Clinica di Cardiologia, Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy. 3. Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, CanadaL8L 2X2. 4. University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, CanadaK1Y 4W7. 5. Klinikum Kassel, 43, Mönchebergstraße 41, 34125 Kassel, Germany. 6. J.W. Goethe University, Theodor-W.-Adorno-Platz 6, 60323 Frankfurt am Main, Germany. 7. Hospital de Santa Creu i Sant Pau, Carrer de Sant Quintí 89, 08026 Barcelona, Spain. 8. Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4-Krc, Czech Republic. 9. Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC, CanadaG1V 4G5. 10. Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. 11. Karolinska Institute, Solnavägen 1, 171 77 Stockholm, Sweden. 12. Centre Hospitalier Universitaire, 2 Rue Henri le Guilloux, 35000 Rennes, France. 13. Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Tel Aviv, Israel. 14. University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA. 15. Institute of Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool, Merseyside L14 3PE, UK. 16. McGill University, 845 Rue Sherbrooke O, Montrèal, QC, CanadaH3A 0G4.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Simon Pecha; Ayhan Ayikli; Iris Wilke; Samer Hakmi; Yalin Yildirim; Nils Gosau; Hermann Reichenspurner; Stephan Willems; Muhammet Ali Aydin Journal: Heart Vessels Date: 2017-10-13 Impact factor: 2.037
Authors: François Philippon; Gilles E O'Hara; Jean Champagne; Stefan H Hohnloser; Michael Glikson; Jörg Neuzner; Philippe Mabo; Xavier Vinolas; Josef Kautzner; Fredrik Gadler; Noa Lashevsky; Stuart J Connolly; Yan Y Liu; Jeff S Healey Journal: CJC Open Date: 2020-04-25
Authors: Sie Kronborg Fensman; Erik Lerkevang Grove; Jens Brock Johansen; Ole Dan Jørgensen; Maria Hee Jung Park Frausing; Rikke Esberg Kirkfeldt; Jens Cosedis Nielsen Journal: J Arrhythm Date: 2022-08-18
Authors: Girish M Nair; David H Birnie; Glen L Sumner; Andrew D Krahn; Jeffrey S Healey; Pablo B Nery; Eli Kalfon; Atul Verma; Felix Ayala-Paredes; Benoit Coutu; Giuliano Becker; François Philippon; John Eikelboom; Roopinder K Sandhu; John Sapp; Richard Leather; Derek Yung; Bernard Thibault; Christopher S Simpson; Kamran Ahmad; Marcio Sturmer; Katherine Kavanagh; Eugene Crystal; George A Wells; Vidal Essebag Journal: Europace Date: 2021-05-21 Impact factor: 5.214