ABSTRACT
BACKGROUND: Surgical site bleeding and infection are potential complications after electrophysiology (EP) device implantation procedures. To date, there is a wide variety of tools for management of intraoperative bleeding but it still remains unclear what methods are preferred. OBJECTIVE: The aim of our study is to compare the rate of complications in patients who underwent cardiac implantable electronic device (CIED) implantation utilizing MPH hemostatic powder to the rate of complications in those patients who underwent standard procedure protocol without MPH hemostatic powder. METHODS: In our study, a new plant-derived microporous polysaccharide hemostatic powder (Arista) was used. A total of 283 consecutive patients were retrospectively studied to assess the rate of complications in patients who underwent CIED implantation with MPH hemostatic powder (n = 77, MPH hemostatic powder) and without (n = 206, no MPH hemostatic powder). Patients were followed for 12 months. RESULTS: The MPH hemostatic powder group of patients had a lower complication rate when compared to no MPH hemostatic powder, 0.3% vs. 1.7% (p < .05), respectively. The rate of device implantation site MPH hematoma in the MPH hemostatic powder group was 0.4%, versus 0.9% in the other group. There were no postoperative infections in the MPH hemostatic powder group versus 3.2% infections in the other group. The main predictor of increased risk of post-procedural complication was the usage of anticoagulation with a hazard ration of 2.7. CONCLUSION: Using MPH hemostatic powder for post-procedural hemostasis was shown to result in a significant reduction in the rate of overall post-procedural complications (a composite endpoint of hematoma and infections), and a trend in reduction of the infections rates and device implantation site hematoma rates.
Subject(s)
Defibrillators, Implantable/adverse effects , Hematoma , Postoperative Hemorrhage , Prosthesis Implantation/adverse effects , Prosthesis-Related Infections , Starch/administration & dosage , Surgical Wound Infection , Aged , Female , Hematoma/etiology , Hematoma/prevention & control , Hemostatics/administration & dosage , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Prosthesis Implantation/methods , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/prevention & control , Retrospective Studies , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , United StatesABSTRACT
Sleep-disordered breathing is a highly prevalent medical condition, which if undiagnosed leads to increased morbidity and mortality, particularly related to increased incidence of cardiovascular events. It is therefore imperative that we identify patient population at high risk for sleep apnea and refer them to the appropriate therapy as early as possible. Up-to-date there is no management guideline specifically geared towards cardiac patients. Thus, we propose a (SAP) Sleep Apnea Pathway to correctly identify and triage these patients to the appropriate therapy.
Subject(s)
Cardiovascular Diseases/prevention & control , Patient Care Management/methods , Sleep Apnea Syndromes , Cardiovascular Diseases/etiology , Humans , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/physiopathology , Sleep Apnea Syndromes/therapyABSTRACT
INTRODUCTION: Dofetilide is a class III antiarrhythmic prescribed to cardiovert persistent atrial fibrillation (AF) to sinus rhythm (SR). HYPOTHESIS: To determine the clinical predictors of cardioversion and readmission in persistent AF patients on dofetilide. METHODS: We analyzed 160 patients with persistent AF who were started on dofetilide and followed for 1 year. We examined age, sex, race, hypertension, diabetes, smoking, dyslipidemia, CAD, left ventricular ejection fraction (LVEF), creatinine, BMI and concomitant use of calcium channel blockers (CCB), ß-blockers in a multivariable logistic regression model. We also examined the same predictors in Cox regression model for AF-related readmission within 1 year of follow-up. RESULTS: 13.5% individuals did not convert to SR on dofetilide. 55.6% converted on the first dose and 83.1% converted by the fourth dose. In multivariable logistic models, dyslipidemia (OR: 2.4, CI: 1.12-5.16) and LVEF (OR: 3.83,CI: 1.37-10.8) were associated with failure to convert with the first dose. Female sex and LVEF also were associated with increased risk of failure to convert at all. Concomitant use of CCB associated with decreased risk of failure to convert to SR. In Cox proportional model, female sex, age <63 years and CAD were associated with increased AF readmission within 1 year. CONCLUSIONS: Dyslipidemia and LVEF <40% were associated with failure to cardiovert after first dose, and female sex and LVEF 40% were related to failure to convert at all on dofetilide in persistent AF patients. After 1-year follow-up, female sex, known CAD, and age <63 years were associated with increased AF readmissions.
