Transvenous pacing leads and systemic thromboemboli in patients with intracardiac shunts - A multicenter study

Article

关键词: CONGENITAL HEART-DISEASE;    PATENT FORAMEN OVALE;    LONG-TERM OUTCOMES;    OF-THE-LITERATURE;    PULMONARY-EMBOLISM;    GREAT-ARTERIES;    PACEMAKER;    ADULTS;    MANAGEMENT;    STROKE;   

DOI  :  10.1161/CIRCULATIONAHA.106.622076

来源: SCIE

【 摘 要 】

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.

【 授权许可】

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