Age, cardiac abnormalities predictors of ICD perforation

For patients with implantable cardioverter-defibrillator (ICD) lead implantations, certain characteristics can predict the risk of cardiac perforation. Based on data from the National Cardiovascular Data Registry (NCDR), researchers found that older age, female sex and left bundle branch block (LBBB) were among the perforation predictors in patients with ICDs.

In a study published online Sept. 3 in Circulation: Cardiovascular Quality and Outcomes, Jonathan C. Hsu, MD, MAS, of the University of California, San Diego, and colleagues utilized the NCDR ICD registry and analyzed data from more than 440,000 patients who underwent ICD implantation for the first time between 2006 and 2011.

“By assessing a large population of ICD recipients, we sought to examine predictors of cardiac perforation from ICD implantation and the magnitude of associated adverse events,” they wrote.

Of the overall study population, 625 patients (0.14 percent) had experienced cardiac perforation. After adjusting for multiple variables, the researchers found that a higher risk for perforation was associated with older patients, females, LBBB, worsening heart failure based on New York Heart Association class, higher left ventricular ejection fraction and non-single-chamber ICD implant.

They also found that several characteristics offered protection against perforation. Atrial fibrillation, diabetes, prior cardiac bypass surgery and higher implanter procedural volume were associated with a lower risk of perforation.

Patients who suffered perforations were at risk for major complications, such as hospital stays longer than three days post-procedure or death in the hospital.

“These findings help to inform implanting physicians about readily identifiable baseline characteristics that may predispose to cardiac perforation and therefore warrant cautionary measures,” the authors concluded.