Implantable Cardioverter-Defibrillator Registry Risk Score Models for Acute Procedural Complications or Death After Implantable Cardioverter-Defibrillator Implantation

Jun 15, 2011
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Authors:
Haines DE, Wang Y, Curtis J.
Citation:
Circulation 2011;123:2069-2076.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What factors are predictive of a high or low risk of complications from implantation of an implantable cardioverter-defibrillator (ICD)?

Methods:

Data from 268,701 ICD implants entered into the NCDR® ICD Registry™ were analyzed. The primary outcome was in-hospital adverse events.

Results:

An acute complication occurred in 3.2% of implants. The most common complications were hematoma (0.9%), lead dislodgement (0.9%), pneumothorax (0.4%), and cardiac arrest (0.3%). The variables found to be the most predictive of a complication were used to develop a risk score: age ≥70 years (1 point), female gender (2 points), class III (1 point) or IV (3 points) heart failure, atrial fibrillation (1 point), prior valve surgery (3 points), device implant for a reason other than generator change (6 points), chronic lung disease (2 points), blood urea nitrogen (BUN) >30 mg/dl (2 points), dual-chamber (2 points) or biventricular (4 points) ICD, and nonelective ICD implantation (3 points). There was a monotonic relationship between risk score and the complication rate, which ranged from a complication rate of 0.6% at a risk score ≤5 to 8% at a risk score ≥19.

Conclusions:

The authors concluded that high- and low-risk patients undergoing ICD implantation can be identified prospectively using a risk score based on simple clinical variables.

Perspective:

The strength of this study is its very large sample size. Its limitations include the possible under-reporting of complications by registry participants and the absence of registry data on complications that occurred after discharge from the hospital. Nevertheless, the results of the study will be helpful in identifying patients who are potential candidates for same-day hospital discharge and patients in whom the risk:benefit ratio of ICD implantation may not be favorable.

Keywords: Risk, Pneumothorax, Heart Failure, Hematoma, Defibrillators, Implantable


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