Abdallah Fayssoil1, Arnaud Lazarus2, Karim Wahbi3, Adam Ogna4, Olivier Nardi4, Frederic Lofaso5, Bernard Clair4, David Orlikowski6, Djillali Annane4. 1. Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France; Clinical Investigation Center CIC 14.29, INSERM, Garches, France. Electronic address: abdallah.fayssoil@aphp.fr. 2. Rhythmology Unit, Clinique Ambroise Paré, Neuilly sur Seine, France; Cardiology Unit, Cochin University Hospital, Paris, France. 3. Cardiology Unit, Cochin University Hospital, Paris, France. 4. Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France. 5. Physiology Department, Raymond Poincare Hospital, Garches, France. 6. Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France; Clinical Investigation Center CIC 14.29, INSERM, Garches, France.
Abstract
BACKGROUND/ OBJECTIVES: Muscular dystrophies are genetic muscle disorders, in which heart involvement and chronic respiratory impairment affect survival. Cardiac conduction disturbances require implantable cardiac pacemaker. Implantable defibrillators may also be necessary to prevent cardiac sudden death. The safety and risk of cardiac electronic devices' implantation are not known in patients with muscular dystrophy. We aimed to assess the risks related to cardiac implantable electronic devices (CIED) in muscular dystrophy patients ventilated by tracheostomy. METHODS: We reviewed all medical charts of neuromuscular patients and identified all CIED implantations of pacemakers (PM) or defibrillators (ICD) in patients ventilated using tracheostomy. RESULTS: Twelve device implantations were included, performed in 9 patients (5 DMD, 1 Becker muscular dystrophy and 3 DM1). Mean age was 39.9years±13.0. All patients were wheel-chair bound and tracheotomized. Six pacemakers (PM) and 6 cardiac resynchronization (CRT) devices, including 2 defibrillators (CRT-D) were implanted. Following device implantation, two patients had a pneumothorax and one died from severe heart failure after an unsuccessful CRT implant attempt. Follow-up lasted up to 8years (mean 2.6±2.9years), during which one patient presented a PM pocket infection, requiring PM explantation and epicardial reimplantation. CONCLUSION: We found a high prevalence of early complications (16.6% pneumothorax) after CIED implantation and an acceptable long-term infectious risk (8.3%). These results highlight the feasibility of CIED implantation in tracheotomized patients with muscular dystrophies and the need for a particular caution in the management of these patients during invasive procedures. ClinicalTrials.gov (identifier: NCT02501083).
BACKGROUND/ OBJECTIVES:Muscular dystrophies are genetic muscle disorders, in which heart involvement and chronic respiratory impairment affect survival. Cardiac conduction disturbances require implantable cardiac pacemaker. Implantable defibrillators may also be necessary to prevent cardiac sudden death. The safety and risk of cardiac electronic devices' implantation are not known in patients with muscular dystrophy. We aimed to assess the risks related to cardiac implantable electronic devices (CIED) in muscular dystrophypatients ventilated by tracheostomy. METHODS: We reviewed all medical charts of neuromuscular patients and identified all CIED implantations of pacemakers (PM) or defibrillators (ICD) in patients ventilated using tracheostomy. RESULTS: Twelve device implantations were included, performed in 9 patients (5 DMD, 1 Becker muscular dystrophy and 3 DM1). Mean age was 39.9years±13.0. All patients were wheel-chair bound and tracheotomized. Six pacemakers (PM) and 6 cardiac resynchronization (CRT) devices, including 2 defibrillators (CRT-D) were implanted. Following device implantation, two patients had a pneumothorax and one died from severe heart failure after an unsuccessful CRT implant attempt. Follow-up lasted up to 8years (mean 2.6±2.9years), during which one patient presented a PM pocket infection, requiring PM explantation and epicardial reimplantation. CONCLUSION: We found a high prevalence of early complications (16.6% pneumothorax) after CIED implantation and an acceptable long-term infectious risk (8.3%). These results highlight the feasibility of CIED implantation in tracheotomized patients with muscular dystrophies and the need for a particular caution in the management of these patients during invasive procedures. ClinicalTrials.gov (identifier: NCT02501083).
Authors: John Bourke; Cathy Turner; William Bradlow; Ashish Chikermane; Caroline Coats; Matthew Fenton; Maria Ilina; Alexandra Johnson; Stam Kapetanakis; Lisa Kuhwald; Adrian Morley-Davies; Ros Quinlivan; Konstantinos Savvatis; Marianela Schiava; Zaheer Yousef; Michela Guglieri Journal: Open Heart Date: 2022-10
Authors: R Quinlivan; B Messer; P Murphy; R Astin; R Mukherjee; J Khan; A Emmanuel; S C Wong; R Kulshresha; T Willis; J Pattni; D Willis; A Morgan; K Savvatis; R Keen; J Bourke; C Marini Bettolo; C Hewamadduma Journal: J Neuromuscul Dis Date: 2021