Predictors of shoulder limitations and disability in patients with cardiac implantable electronic devices: Importance of device size

Abstract

Background: Generator-induced shoulder impairment is a common complication of cardiac implantable electronic device (CIED) implantation. Although implantable cardioverter-defibrillators (ICDs) have become smaller in size, they are still bigger than pacemakers (PMs). This study aimed to investigate the effects of single-chamber PM and ICD sizes on shoulder function. Methods: This retrospective study included 200 consecutive patients, of whom 123 had PMs and 77 had ICDs. The CIED implantation effects on shoulder function, pain, disability, and quality of life (QoL) were evaluated. The range of motion (ROM), Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and Short Form-36 (SF-36) Health Survey (Physical and Mental Component Summary [PCS and MCS]) were used. Results:The flexion and abduction range limitation rates were significantly higher in the ICD group than in the PM group (16.9% vs. 7.3%, p = .035 and 19.5% vs. 8.9%, p = .031, respectively). The two groups had similar VAS scores. The median QuickDASH score was significantly higher in the ICD group than in the PM group (8.2 [3.6-19.6] vs. 4.6 [2.6-17.9], p = .034). There were no significant differences in SF-36 components between the two groups. ICD implantation (OR: 1.642, 95% CI: 1.293-2.776; p = .001) and incision length (OR: 1.343, 95% CI: 1.194-2.064; p = .01) were independent predictors of shoulder ROM limitations.Conclusions: Reduced device sizes with advancing technology can decrease shoulder functional limitations and disability after implantation. Healthcare professionals should not neglect shoulder evaluations during the pre-and postimplantation periods.

Relationship between CIED extent of displacement toward the shoulder while in the supine position and shoulder impairment

“…Also, an incision length increase in proportion to device size was associated with shoulder disorders. 18 The device's proximity to the shoulder girdle muscles (pectoralis major and deltoid) and the restriction of arm movements due to anxiety about device malfunction and pain are the main mechanisms underlying the development of shoulder impairment in CIED recipients. 11 A consequence of this is shoulder elevation due to an antalgic posture.…”

“…A recent study showed that shoulder impairment was twice as frequent among recipients of ICDs than among PM recipients. Also, an incision length increase in proportion to device size was associated with shoulder disorders 18 . The device's proximity to the shoulder girdle muscles (pectoralis major and deltoid) and the restriction of arm movements due to anxiety about device malfunction and pain are the main mechanisms underlying the development of shoulder impairment in CIED recipients 11 .…”

“…The device size and weight and the associated incision length have been implicated in shoulder disorders. 18 The device's position is not static and can be displaced by gravity, sliding to the craniolateral side when in the supine position and to the caudomedial side when standing. 19 We hypothesized that excessive displacement of the device toward the shoulder while in the supine position might cause shoulder impairment by contacting more muscle fibers and coming too close to the shoulder joint.…”

Efficacy and safety of different exercises in preventing cardiac implantable electronic device‐related shoulder impairment

“…CIEDs can be inserted using various approaches to lead and generator placement. Device sizes are becoming smaller with technological advancements, and surgical techniques are being improved continuously 5 . As a consequence, subpectoral placement has shifted to prepectoral placement 6 .…”

“…Device sizes are becoming smaller with technological advancements, and surgical techniques are being improved continuously. 5 As a consequence, subpectoral placement has shifted to prepectoral placement. 6 Currently, the most preferred procedure is the transvenous subcutaneous prepectoral approach.…”