ABSTRACT
Objective:
To investigate the prevalence and reopen the drive procedure of early complications of electrode dislodgement in patients with an indication for permanent pacemaker implantation at the Vietnam National Heart Institute.
Methods:
This is a study on patients who received permanent pacemaker implantation at the Vietnam National Heart Institute during the period from August 1, 2019 to March 30, 2020.
Results:
In all cases with complications of electrode dislodgement after implantation indicated to reopen the machine to handle complications, the results of handling complications are safe and stable.
Conclusion:
There is a positive relationship between the events of electrode dislodgement on the pacemaker and the degree of tricuspid valve regurgitation with a statistically significant difference (P < 0.01, OR = 8.2; 95% CI: 1.6–42.9).
KEYWORDS: Early complication, electrode dislodgement, permanent pacemaker implantation
INTRODUCTION
Cardiac pacemakers have brought many benefits in clinical practice to help reduce mortality and improve quality of life in patients with indications for implantation.[1,2,3] The location of complications or complications due to cardiac pacemakers such as arrhythmia, cardiac pacemaker syndrome, electrode dislodgement, and outlet block can affect the patient’s life.[4,5] Therefore, we conducted this study with the main objective of surveying the prevalence and clinical characteristics of early complications of electrode dislodgement in patients with permanent pacemaker implantation at the Vietnam National Heart Institute–Bach Mai Hospital.
METHODS
Inclusion criteria
The patient was a permanent pacemaker implanted with one of the machines: one-chamber cardiac pacemakers and two-chamber cardiac pacemakers (atrium–ventricle). An ICD (implantable cardioverter defibrillator) and a cardiac resynchronization therapy (CRT) machine were used, and patients consented and voluntarily participated in the study.
Exclusion criteria
Patients who have permanent pacemaker implantation but who also experience severe disease or death from other causes, cardiac pacemaker implantation in the epicardium, and wireless cardiac pacemakers were excluded.
Methods
Study design
A cross-sectional, prospective descriptive study. Variables in study: General information about study subjects, ECG parameters, comparison before and after implantation to find out new arrhythmias, parameters on echocardiography before or after implantation, INR test, blood count, platelet count, and basic clinical characteristics.
RESULTS
As a result [Table 1], there are 6 patients (2.04%) who need to reopen the drive, all of which are complications of electrode dislodgement.
Table 1.
Characteristics of some factors and complications of electrode dislodgement
| Parameter | Quality (ratio) | |
|---|---|---|
|
| ||
| Complications (n=6) | None-Complication (n=288) | |
| The degree of tricuspid valve regurgitation | ||
| Severe tricuspid valve regrurgitation | 3 (8.82) | 31 (91.18) |
| None Severe tricuspid valve regrurgitation | 3 (1.15) | 257 (97.35) |
| History of heart surgery | ||
| Yes | 1 (5.88) | 16 (94.12) |
| None | 5 (2.30) | 212 (97.70) |
| Pulmonary artery pressure | ||
| 45 | 1 (2.86) | 34 (97.14) |
| <45 | 5 (1.93) | 254 (98.07) |
| Position of right atrium (n=207) | ||
| Atrial appendage | 4 (2.05) | 191 (97.95) |
| Free Wall | 0 (0.0) | 9 (100.0) |
| Atrial Septum | 0 (0.0) | 3 (100.0) |
| Position of right ventricle (n=246) | ||
| Interventricular Septum | 5 (2.34) | 209 (97.66) |
| Right Ventricular Apex | 1 (4.35) | 70 (95.65) |
| Right Ventricular Outflow Tract | 0 (0.0) | 4 (100) |
| Budle of His | 0 (0.0) | 5 (100) |
The results [Table 2] showed that there were 6 patients (2.04%) who had complications with electrode dislodgement after implantation, of which 4 cases had atrial flutter, 2 cases had ventricular turning on electrodes, 4 patients were detected by chest X-ray, and 2 patients were detected by machine programming.
Table 2.
Switching on electrodes after implantation
| Feature | Quantity (n=294) | Ratio (%) |
|---|---|---|
| Position | ||
| Ventricular Electrode | 2 | 0.68 |
| Atrial Electrode | 4 | 1.36 |
| Detection Method | ||
| Chest X-Ray | 4 | 1.36 |
| Pacemaker check & programming | 2 | 0.68 |
| Clinical Symptoms | ||
| Yes | 3 | 1.02 |
| None | 3 | 1.02 |
| Re-Surgery to Electrode Dislodgement | 6 | 100.0 |
The results of Table 3 show that the degree of mitral regurgitation increases the complication of stroke with statistical significance with P = 0.003 < 0.05 (OR = 8.2; 95% CI: 1.6–42, 9); other factors such as pulmonary artery pressure and history of cardiac surgery have not been found to be associated with this complication. There has also been no association with the location of ventricular and atrial electrodes to this complication.
Table 3.
Some factors related to the electrode dislodgement complication
| Parameter | Quantity (Ratio) | P, OR | |
|---|---|---|---|
|
| |||
| Complication (n=6) | None Complication (n=288) | ||
| The degree of Tricuspid Valve Regrurgitation | |||
| Severe Tricuspid Valve Regurgitation | 3 (8.82) | 31 (91.18) |
P<0.05; OR=8.2 95% CI (1.6-42.9) |
| None severe Tricuspid Valve Regurgitation | 3 (1.15) | 257 (97.35) | |
| History of Heat Surgery | |||
| Yes | 1 (5.88) | 16 (94.12) | |
| None | 5 (2.30) | 212 (97.70) | P>0.05 |
| Pulmonary Artery Pressure | |||
| ≥45mmHg | 1 (2.86) | 34 (97.14) | |
| <45 mmHg | 5 (1.93) | 254 (98.07) | P>0.05 |
| Position of Right Atrium (n=207) | |||
| Atrial appendage | 4 (2.05) | 191 (97.95) | |
| Free Wall | 0 (0.0) | 9 (100) | P>0.05 |
| Atrial Septum | 0 (0.0) | 3 (100) | |
| Position of Right Ventricle (n=246) | |||
| Interventricular Septum | 5 (2.34) | 209 (97.66) | |
| Right Ventricular Apex | 1 (4.35) | 70 (95.65) | P>0.05 |
| Right Ventricular Outflow Tract | 0 (0.0) | 4 (100) | |
| Budle of His | 0 (0.0) | 5 (100) | |
| Total (n, %) | 6 (100%) | 288 (100%) | |
DISCUSSION
For factors related to electrode dislodgement in our study, we found that factors that increase the risk of this complication such as severe tricuspid valve regurgitation (P < 0.01) did not see a relationship between the position of the right atrium, position of the right ventricle, pulmonary artery pressure, and history of heart surgery with this complication (P > 0.05). Therefore, the implementation of cardiac pacemaker implantation procedure on patients with severe tricuspid valve regurgitation needs to be very careful, meticulous, and precise in order to limit the possible complications of electrode dislodgement in these patients. Some studies also show an increased rate of electrode dislodgement in the group with right ventricular dilatation and severe tricuspid valve regurgitation;[6] this is also consistent with severe tricuspid valve regurgitation or right ventricular dilatation, which will cause difficulties and loss of more time for the fixation of the atrial electrode.[7]
CONCLUSION
The procedure resulted in the fact that 100% of the cases with electrode dislodgement were intervened to reopen the engine drive to handle the accident and repair their electrodes; the procedure was performed to reopen the drive once in a safe and stable way.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: Calendar year 2009 –A World Society of Arrhythmia's project. Pacing Clin Electrophysiol. 2011;34:1013–27. doi: 10.1111/j.1540-8159.2011.03150.x. [DOI] [PubMed] [Google Scholar]
- 2.Pham NH, Ta TP, Tran VD. Review of classic indications for pacemakers on the basis of clinical studies. Vietnam J Cardiol. 2014;65:99–107. [Google Scholar]
- 3.Vanezis AP, Prasad R, Andrews R. Pacemaker leads and cardiac perforation. JRSM Open. 2017;8:2054270416681432. doi: 10.1177/2054270416681432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Carrión-Camacho M, Marín-León I, Molina-Doñoro J, González-López JR. Safety of permanent pacemaker implantation: A prospective study. J Clin Med. 2019;8:35. doi: 10.3390/jcm8010035. doi: 10.3390/jcm8010035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Link MS, Estes NM, Griffin JJ, Wang PJ, Maloney JD, Kirchhoffer JB, et al. Complications of dual chamber pacemaker implantation in the elderly. J Interv Card Electrophysiol. 1998;2:175–9. doi: 10.1023/a:1009707700412. [DOI] [PubMed] [Google Scholar]
- 6.Leong KM, Pollard C, Cooke CJ. Cardiology registrars and permanent pacemaker complications rates in a district general hospital-safety and service implications. Clin Med. 2014;14:34. doi: 10.7861/clinmedicine.14-1-34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Eberhardt F, Bode F, Bonnemeier H, Boguschewski F, Schlei M, Peters W, et al. Long-term complications in single and dual chamber pacing are caused by surgical experience and patient morbidity. Heart. 2005;91:500–6. doi: 10.1136/hrt.2003.025411. [DOI] [PMC free article] [PubMed] [Google Scholar]