Device Results - 01/01/2013 - 31/12/2013

I undertook 159 procedures in 2013. 75% were on men. The average age was 72.7±12.8 years. 41 patients were taking warfarin. The mean body mass index was 28.0 Kg/m2. The mean EGFR was 69 ml/min. During the year we moved from Flucloxacillin and Gentamycin to Teicoplanin and Gentamycin as prophylactic antibiotics. We also moved towards using a hibiscrub wash in all patients, regardless of MRSA or MSSA status. 

 

I undertook the following procedures:

 

VVIR

Box Change

1

 

New

21

 

Revision

1

DDDR

Box Change

2

 

New

34

 

Revision

2

CRT-P

Box Change

3

 

New

12

 

Revision

7

VVIR ICD

Box Change

1

 

New

14

 

Revision

2

DDDR ICD

Box Change

16

 

New

6

 

Revision

4

CRT-D

Box Change

5

 

New

14

 

Revision

14

 

Total

159

 

There were 120 subclavian punctures, 62 right atrial leads placed, 113 right ventricular leads placed and 44 left ventricular leads placed.

 

Complications

 

My infection rate was 1.9%, my lead displacement rate was 0.9%, my pneumothorax rate was 0% and my haematoma requiring re-intervention rate was 0%. My cardiac perforation rate was 0%. Overall my significant complication rate for the year was 2.5%. In a recent Danish cohort, the risk of complications was 5.6% overall (Kirkefeldt et al. 2013).

 

4 patients experienced significant complications:

 

  1. IL had an infection requiring extraction after a DDDR ICD box change and new RV lead.
  2. SM had an infection requiring extraction after a new DDDR ICD. Update: I extracted his re-implanted device on 13th February. We have agreed not to implant a third.
  3. MM had an infection requiring extraction after a DDDR ICD box change.
  4. OR had a new CRT-D inserted. The first LV lead moved. The second LV lead also moved. I have never had this happen before or since. I asked a colleague in London to place a third LV lead.

 

Other Events

 

  1. DP was listed for an upgrade to a CRT-D. There were no suitable targets into which I was able to place a lead without diaphragmatic pacing. His QRS duration was marginal and thus I have not reattempted the procedure or sent him for surgery.
  2. JS had an upgrade to a CRT-D. He had a suitable target vessel but there was diaphragmatic pacing where the lead was stable. I brought him back when quadripolar leads became available later in the year and undertook a second procedure successfully.

Finally AP had a CRT-P device placed uneventfully. His echo the previous week (which I had not seen) showed normal LV function, which was a considerable and unexpected improvement, given his previous echo findings of severe LV dysfunction. I have apologised for this.

 

2014 is not going as well at present. One infection and one A lead displacement. Plus the re-presentation of SM.

 

Device Results 2013
Audit 2013.doc
Microsoft Word document [40.0 KB]