Author + information
- Received May 22, 2018
- Revision received August 20, 2018
- Accepted August 20, 2018
- Published online September 26, 2018.
- Rohith Nayak, BAa,
- Timothy M. Fernandes, MD, MPHb,
- William R. Auger, MDa,
- G. Victor Pretorius, MBChBc,
- Michael M. Madani, MDc and
- Ulrika M. Birgersdotter-Green, MDd,∗ ()
- aDepartment of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
- bDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California
- cDepartment of Surgery, University of California, San Diego, La Jolla, California
- dDivision of Cardiovascular Medicine, University of California, San Diego, La Jolla, California
- ↵∗Address for correspondence:
Dr. Ulrika Birgersdotter-Green, Pacemaker and ICD Services, UC San Diego Health, Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of California, San Diego, 9452 Medical Center Drive, MC 7411, Altman Building, 3rd Floor, Room 3E-313, La Jolla, California 92037.
Objectives This study aimed to identify the prevalence of cardiac implantable electronic devices (CIEDs) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to describe the associated disease burden.
Background CTEPH is a debilitating disease, now potentially curable with pulmonary thromboendarterectomy (PTE). The contribution of CIEDs to thrombosis in this patient population has not been previously studied.
Methods The charts of 982 CTEPH patients, who underwent PTE between January 1, 2009 and December 31, 2015 at University of California San Diego (UCSD) Medical Center, were reviewed for pacemakers or implantable cardioverter defibrillators (ICDs) implanted before surgery.
Results Among 982 CTEPH patients who underwent PTE, 14 had pacemakers and 3 had ICDs, giving 17 CIEDs and a prevalence of 1.7%. Of these 17 CIEDs, 6 devices were extracted intraoperatively, and 5 of 6 devices were replaced with epicardial leads. Furthermore, of the 950 patients classified by intraoperative UCSD level, 12 of 17 (70.6%) patients with CIEDs had distal disease versus 241 of 933 (25.8%) patients without CIEDs (p = 0.0002). The prevalence of known venous thromboembolism (VTE) was 50% in CIED patients compared with 78.6% in patients without CIEDs (p = 0.018).
Conclusions At 1.7%, the prevalence of CIEDs in the PTE population was higher than previously reported values, which estimated CIED prevalence between 0.16% and 0.47% in the general population. Moreover, CTEPH patients with CIEDs were more strongly associated with distal disease burden and less likely to have had previous VTE, which suggested that CIEDs may be a nidus for small clots that embolize distally in the pulmonary vasculature.
Dr. Fernandes has been a consultant for MSD/Bayer and has been a speaker for Bayer Pharmaceuticals. Dr. Auger has been a consultant for MSD/Bayer and has received grant support from Bayer. Dr. Madani has been consultant for MSD/Bayer, Johnson & Johnson, and Wexler Surgical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 22, 2018.
- Revision received August 20, 2018.
- Accepted August 20, 2018.
- 2018 American College of Cardiology Foundation
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