Dinesen, PT

Elgaard, AF

Johansen, JB

Larsen, JM

Lundbye-Christensen, S

Nielsen, JC

Riahi, S

English

    Aalborg UniversitetRisk of complications following external cardioversion in cardiovascular implantableelectronic devices with and without generator replacementElgaard, AF; Dinesen, PT; Riahi, S; Lundbye-Christensen, S; Johansen, JB; Nielsen, JC;Larsen, JMPublished in:EuropaceDOI (link to publication from Publisher):10.1093/europace/euad122.075Creative Commons LicenseCC BY-NC-ND 4.0Publication date:2023Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Elgaard, AF., Dinesen, PT., Riahi, S., Lundbye-Christensen, S., Johansen, JB., Nielsen, JC., & Larsen, JM.(2023). Risk of complications following external cardioversion in cardiovascular implantable electronic deviceswith and without generator replacement. Europace, 25(Suppl. 1), Article euad122.075.https://doi.org/10.1093/europace/euad122.075General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            - Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            - You may not further distribute the material or use it for any profit-making activity or commercial gain            - You may freely distribute the URL identifying the publication in the public portal -Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Risk of complications following external cardioversion in cardiovascular implantableelectronic devices with and without generator replacementMr Elgaard AF; Ms Dinesen PT; Professor Riahi S; Associate Professor Lundbye-Christensen S; Associate Professor Johansen JB;Professor Nielsen JC; Associate Professor Larsen JM.Aalborg University Hospital, Department of Cardiology and Department of Clinical Medicine, Aalborg, DenmarkAalborg University Hospital, Department of Anaesthesia and Intensive Care Medicine, Aalborg, DenmarkAalborg University Hospital, Department of Research data and Statistics, Aalborg, DenmarkOdense University Hospital, Department of Cardiology, Odense, DenmarkAarhus University Hospital, Department of Cardiology and Department of Clinical Medicine, Aarhus N, DenmarkFunding Acknowledgements: Type of funding sources: Foundation. Main funding source(s): Karl G. Andersen FoundationIntroduction: External cardioversion (ECV) with transthoracic shock is a standard procedure to control atrial fibrillation and flutter in patientsregardless of whether cardiovascular implantable electronic devices (CIED) are in situ. Studies have demonstrated infrequent ECV-relatedCIED malfunction, requiring device re-interventions, but the mechanisms seem heterogeneous. We hypothesized, that replaced CIEDgenerators are more vulnerable to ECV procedures, maybe caused by insulation defects. The aim of this study is to investigate the long-termrisk of complications following ECV in CIEDs with or without previous generator replacement.Methods: All CIED implants and re-operations in Denmark were identified in the Danish Pacemaker and ICD Register and ECVs were identifiedin the Danish National Patient Registry from January 2010 to February 2019. We identified CIED patients with and without previous generatorreplacement. Inclusion was at the time of first ECV. Time to generator replacement with the same type and lead re-intervention with the samelead type after ECV were calculated independently, using Cox regression with death, generator extraction, and system up-/down-grade beingcompeting events. The cause-specific hazard ratios (HR) were calculated using inverse probability of treatment balancing patient age and sexand stratified for the different types of CIED and lead, allowing different baseline hazard functions (1).Results:We identified 515 CIED patients with previous generator replacement and 1,878 CIED patients without generator replacement. Meanage of patients at inclusion was 68.7±11.7 years with 74% men and the median generator and lead implant times were 1.6 years (0.9 yearswithout replacement) and 3.0 years (0.7 years without replacement) before ECV. The types of CIED included 50% of pacemakers, 30% ofImplantable Cardioverter Defibrillators, 6% of Cardiac Resynchronization Therapy-Pacemaker, and 14% of Cardiac ResynchronizationTherapy-Defibrillators. During the first 3 years of follow-up, 92 (18%) of the patients with replaced generator had an additional generatorreplacement compared to 161 (9%) of the patients without generator replacement. The type of leads included 38% atrial leads, 26% rightventricle leads, 13% left ventricle leads, and 23% high voltage leads. During the first 3 years of follow-up, 71 (8%) of the patients with a replacedgenerator had lead re-intervention compared to 191 (5%) of the patients without a replaced generator. The HR of generator replacement was2.00 (95%CI:1.51;2.64, p<0.001) and 1.60 (95%CI:1.21;2.12, p=0.001) balancing generator implant time. The HR of lead re-intervention was1.62 (95%CI:1.21;2.16, p=0.001).Conclusion: Wearing a contemporary cardiovascular implantable electronic device with a prior generator replacement is associated with atwo-fold increased risk of additional generator replacement and an increased risk of lead re-intervention following external cardioversion.Europace 2023 Volume 25 Supplement 1 i11910.4.3 - Rhythm Control, CardioversionDownloaded from https://academic.oup.com/europace/article/25/Supplement_1/euad122.075/7176860 by Medicinsk Bibliotek, Aalborg Sygehus SYD user on 06 December 2023Figure 1i120 Europace 2023 Volume 25 Supplement 110.4.3 - Rhythm Control, CardioversionDownloaded from https://academic.oup.com/europace/article/25/Supplement_1/euad122.075/7176860 by Medicinsk Bibliotek, Aalborg Sygehus SYD user on 06 December 2023

Risk of complications following external cardioversion in cardiovascular implantable electronic devices with and without generator replacement

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Risk of complications following external cardioversion in cardiovascular implantable electronic devices with and without generator replacement

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