SPC365

Safety of same-day vs next-day discharge after CIED: a single-center experience

Session: Posters (Sessão 3 - Écran 3) - Arrítmias 4 - Vários
Speaker: Pedro Silvério António

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.2 Implantable Cardioverter / Defibrillator
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Pedro Silvério António; Sara Couto Pereira; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Catarina Oliveira; Miguel Raposo; Catarina Gregório; Ana Bernardes; Afonso Nunes-Ferreira; Andreia Magalhães; Luis Carpinteiro; Helena Cristina; Fausto j. Pinto; João de Sousa; Pedro Marques

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Despite the increasing number of cardiac implantable electronic devices (CIED) implanted worldwide there is no guideline recommending mandatory overnight hospital stay.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To evaluate the safety of Same Day Discharge (SDD) after CIED implantation.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Retrospective single-center observational study of consecutive patients (pts) admitted in the cardiology department since 2018 for permanent pacemaker (PPMK) or implantable cardioverter defibrillators (ICDs) implantation. Pacemaker-dependent pts and pts with early complications (moderate or severe hematomas pneumothorax, pericardial effusion/cardiac tamponade) were excluded from this study. Safety endpoints were pneumothorax, lead dislodgement, cardiac perforation, pocket hematoma, pocket/device infection and death.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Sixty-nine pts (75 &plusmn; 12 yrs, 37.7% female) included in the SDD group were compared to 259 pts (76 &plusmn; 11 yrs, 32.4% female) in the next-day discharge (NDD) group. The analysis included 287 PPMK (60 in SDD vs 227 in NDD) and 41 ICD (9 in SDD vs 31 in NDD) patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Baseline patient profile were similar between the two groups: chronic kidney disease (SDD 13% vs NDD 8%), oral anticoagulation (SDD 39% vs NDD 51%) and venous access (SDD 73% vs NDD 75%); except for atrial fibrillation that was more frequent in the NDD group (54% vs 38%, p=0.02). Time of fluoroscopy and time of implantation were&nbsp;similar between the two groups.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A very low rate of complications was observed in both groups: in 4.3% of pts in SDD group and in 5.1 % of pts in NDD group, without statistical significance between the two groups (p=0.43). Early complications (&lt; 30 days) occurred in 1 (1.4%) pt in the SDD group (haematoma) and in 9 (3.4%) pts in the NDD group (4 haematoma, 3 pocket infection and 2 lead dislodgment), without statistical significance (p=0.85).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">After a mean follow-up of 22.5 &plusmn; 13 months, late complications (&gt;30 days) in both groups were similar (p=0.21) &ndash; SDD group had 2 (2.9%) pts with lead dislodgment, which needed surgical revision; NDD group had 3 (1.2%) pts (1 lead endocarditis and 2 lead dislodgment) which need surgical revision.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: In our center, SDD for CIED is safe and effective compared to NDD. This can represent a significant cost reduction. Larger prospective trials are needed to further evaluate this issue.</span></span></span></p>

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