Death After Ablations and Device Implants

Study Questions:

What are the in-hospital rates of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures?

Methods:

This was a retrospective cohort study of 48,913 patients (mean age 65.7 years) who underwent 62,065 HRDM procedures at three academic centers in 2000-2016. All cases of in-hospital death and CVEs were analyzed.

Results:

The rates of death and CVEs were 0.36% and 0.12%, respectively. The majority (86%) of deaths were not a direct consequence of the HRDM procedure. The highest mortality rate (1.9%) and CVE rate occurred in patients who underwent lead extraction. Device implantations accounted for 48% of deaths directly related to the HRDM procedure. Cardiac tamponade was the most frequent direct cause of death (40%). The most common indirect cause of death was infection (29%). The overall mortality rate at 30 days post-procedure was 0.76%. Subgroup analysis indicated that the highest 30-day mortality rate occurred in associated with lead extractions (3.08%) and device implants (0.94%).

Conclusions:

The most common direct cause of death after a HRDM procedure is cardiac tamponade, and this is most likely to occur in patients undergoing a lead extraction.

Perspective:

This very large study confirms the findings of a smaller prior study that also demonstrated that only a minority of deaths after a HRDM procedure are a direct consequence of the procedure. Cardiac tamponade was by far the most common cause of death resulting directly from the HRDM procedure. This highlights the importance of training electrophysiology laboratory personnel in the early recognition and treatment of cardiac tamponade.

Clinical Topics: Arrhythmias and Clinical EP, Pericardial Disease, Prevention, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Ablation Techniques, Cerebrovascular Trauma, Cardiac Tamponade, Cardiac Electrophysiology, Heart Conduction System, Hospital Mortality, Infection, Secondary Prevention, Vascular Diseases


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