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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:

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.