Cardiac device implantations in obese patients: Success rates and complications

Abstract

Background Obesity is associated with increased complications and potentially worse outcomes for various cardiac interventions. This study analyzed the success rate and complication rates associated with implantation of cardiac implantable electronic devices (CIEDs) in obese patients. Hypothesis Success rates are lower and complication rates higher in obese patients. Methods Consecutive patients undergoing CIED implantation between 2011 and 2015 in our hospital were included. Patients were categorized into obese and nonobese groups according to body mass index (BMI); cutoff was 30 kg/m2. Patient characteristics, complication rates, procedural duration, and fluoroscopy data were compared between the 2 groups. Results A total of 965 patients (mean age, 69.0 ± 12.9 years; 67% male) were included. Of these, 249 (25.8%) patients were classified obese and 716 (74.2%) nonobese. Mean BMI was 34.7 ± 4.7 kg/m2 vs 25.1 ± 3.0 kg/m2, respectively. There was no difference in procedural success rates between the 2 groups (97.2% vs 97.1%, respectively). Major complications were significantly lower in the obese group compared with the nonobese group (11 [4.4%] vs 62 [8.7%]; P < 0.05). Procedural duration and fluoroscopy duration were not different between the 2 groups, but the total dose‐area product was significantly higher in obese patients vs nonobese patients (4012 ± 5416 cGcm2 vs 2692 ± 5277 cGcm2 ; P < 0.005). Conclusions CIED implantation can be safely and effectively achieved in patients with BMI >30 kg/m2. However, total radiation dose was significantly higher in the obese group, emphasizing that efforts should be made to reduce radiation exposure in these patients.

Evaluation of a new ultralow-dose radiation protocol for electrophysiological device implantation: A near-zero fluoroscopy approach for device implantation

“…In accordance with the results of other studies, we found that higher BMI 22,23 and longer fluoroscopy time 14,24 were the main factors predicting the need for higher radiation doses.…”

Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta‐analysis

“…ZMF guiding for CIEDs implantation provides benefits for both patients and medical staffs. The magnitude of fluoroscopy radiation depends on the clinical indications, comorbidities, and device type 33,34 . Patients with long, multiple, and complicated procedures had higher risks of radiation injury, especially skin injuries (20 min or more of high contrast fluoroscopy or 60 min of low fluoroscopy) 4 .…”

“…The magnitude of fluoroscopy radiation depends on the clinical indications, comorbidities, and device type. 33 , 34 Patients with long, multiple, and complicated procedures had higher risks of radiation injury, especially skin injuries (20 min or more of high contrast fluoroscopy or 60 min of low fluoroscopy). 4 As important as the patients, medical staffs, namely interventional cardiologists, electrophysiologists, and cardiac catheterization laboratory technicians also had an increased risk of radiation‐associated injuries, such as skin lesions, orthopedic problems, cataracts, and hypercholesterolemia.…”

Efficacy and safety of axillary vein puncture real-time guided by roadmap fluoroscopy in cardiac pacemaker implantation

“…[5,6] However, severe complications can occur in clinical practice, such as pneumothorax, hemothorax, arterial puncture, and brachial plexus injury. [7,8] To overcome the inherent limitations, we apply new roadmap fluoroscopy approach to guide the axillary vein puncture. Roadmap real-time guided puncture may overcome this issue, enabling an effective puncture to enhance visualization with a safer procedure.…”