Document Detail


Transvenous pacing leads and systemic thromboemboli in patients with intracardiac shunts: a multicenter study.
MedLine Citation:
PMID:  16702467     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The risk of systemic thromboemboli associated with transvenous leads in the presence of an intracardiac shunt is currently unknown. METHODS AND RESULTS: To define this risk, we conducted a multicenter, retrospective cohort study of 202 patients with intracardiac shunts: Sixty-four had transvenous leads (group 1), 56 had epicardial leads (group 2), and 82 had right-to-left shunts but no pacemaker or implantable cardioverter defibrillator leads (group 3). Patient-years were accrued until the occurrence of systemic thromboemboli or study termination. Censoring occurred in the event of complete shunt closure, death, or loss to follow-up. Mean ages for groups 1, 2, and 3 were 33.9+/-18.0, 22.2+/-12.6, and 22.9+/-15.0 years, respectively. Respective oxygen saturations were 91.2+/-9.1%, 88.1+/-8.1%, and 79.7+/-6.7%. During respective median follow-ups of 7.3, 9.3, and 17.0 years, 24 patients had at least 1 systemic thromboembolus: 10 (15.6%), 5 (8.9%), and 9 (11.0%) in groups 1, 2, and 3, respectively. Univariate risk factors were older age (hazard ratio [HR], 1.05; P=0.0001), ongoing phlebotomy (HR, 3.1; P=0.0415), and an transvenous lead (HR, 2.4; P=0.0421). In multivariate, stepwise regression analyses, transvenous leads remained an independent predictor of systemic thromboemboli (HR, 2.6; P=0.0265). In patients with transvenous leads, independent risk factors were older age (HR, 1.05; P=0.0080), atrial fibrillation or flutter (HR, 6.7; P=0.0214), and ongoing phlebotomy (HR, 14.4; P=0.0349). Having had aspirin or warfarin prescribed was not protective. Epicardial leads were, however, associated with higher atrial (P=0.0407) and ventricular (P=0.0270) thresholds and shorter generator longevity (HR, 1.9; P=0.0176). CONCLUSIONS: Transvenous leads incur a >2-fold increased risk of systemic thromboemboli in patients with intracardiac shunts.
Authors:
Paul Khairy; Michael J Landzberg; Michael A Gatzoulis; Lise-Andrée Mercier; Susan M Fernandes; Jean-Marc Côté; Jean-Pierre Lavoie; Anne Fournier; Peter G Guerra; Alexandra Frogoudaki; Edward P Walsh; Annie Dore;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2006-05-15
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-23     Completed Date:  2006-06-02     Revised Date:  2006-12-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2391-7     Citation Subset:  AIM; IM    
Affiliation:
Adult Congenital Heart and Electrophysiology Services, Montreal Heart Institute, Montreal, Canada. paul.khairy@umontreal.ca
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MeSH Terms
Descriptor/Qualifier:
Arteriovenous Shunt, Surgical / methods*
Cardiac Pacing, Artificial
Cohort Studies
Follow-Up Studies
Heart Defects, Congenital / classification,  epidemiology,  surgery*
Humans
Incidence
Intraoperative Complications / epidemiology
Pacemaker, Artificial
Proportional Hazards Models
Retrospective Studies
Thromboembolism / epidemiology,  surgery*
Comments/Corrections
Comment In:
Nat Clin Pract Cardiovasc Med. 2006 Dec;3(12):646-7   [PMID:  17122793 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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