ABC | Volume 112, Nº5, May 2019

Original Article Unscheduled Emergency Visits after Cardiac Devices Implantation: Comparison between Cardioverter Defibrillators and Cardiac Resynchronization Therapy Devices in less than one year of Follow Up Stefan Warpechowski Neto, 1 Laura Lessa Gaudie Ley, 2 Eduardo Dytz Almeida, 1 Marco Aurélio Lumertz Saffi, 3 Luiza Zwan Dutra, 1 Antonio Lessa Gaudie Ley, 1 Roberto Tofani Sant`Anna, 1 Gustavo Glotz de Lima, 1 Renato Abdala Karam Kalil, 1 Tiago Luiz Luz Leiria 1 Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), 1 Porto Alegre, RS – Brazil Pontifícia Universidade Católica do Rio Grande do Sul, 2 Porto Alegre, RS – Brazil Hospital de Clínicas de Porto Alegre, 3 Porto Alegre, RS – Brazil Mailing Address: Tiago Luiz Luz Leiria • Av. Princesa Isabel, 370. Postal Code 90620-000, Santana. Porto Alegre, RS – Brazil E-mail: pesquisa.leiria@gmail.com, editoracao-pc@cardiologia.org.br Manuscript received June 04, 2018, revised manuscript September 05, 2018, accepted September 05, 2018 DOI: 10.5935/abc.20190018 Abstract Background: The use of Cardiovascular Implantable Electronic Devices (CIED), such as the Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT), is increasing. The number of leads may vary according to the device. Lead placement in the left ventricle increases surgical time and may be associated with greater morbidity after hospital discharge, an event that is often confused with the underlying disease severity. Objective: To evaluate the rate of unscheduled emergency hospitalizations and death after implantable device surgery stratified by the type of device. Methods: Prospective cohort study of 199 patients submitted to cardiac device implantation. The groups were stratified according to the type of device: ICD group (n = 124) and CRT group (n = 75). Probability estimates were analyzed by the Kaplan-Meier method according to the outcome. A value of p < 0.05 was considered significant in the statistical analyses. Results: Most of the sample comprised male patients (71.9%), with a mean age of 61.1 ± 14.2. Left ventricular ejection fraction was similar between the groups (CRT 37.4 ± 18.1 vs. ICD 39.1 ± 17.0, p = 0.532). The rate of unscheduled visits to the emergency unit related to the device was 4.8% in the ICD group and 10.6% in the CRT group (p = 0.20). The probability of device-related survival of the variable “death” was different between the groups (p = 0.008). Conclusions: Patients after CRT implantation show a higher probability of mortality after surgery at a follow-up of less than 1 year. The rate of unscheduled hospital visits, related or not to the implant, does not differ between the groups. (Arq Bras Cardiol. 2019; 112(5):491-498) Keywords: Defibrillators, Implantable; Cardiac-Gated Imaging Techniques; Cardiac Resynchronization Therapy Devices; Patient Readmission; Mortality. Introduction In the cardiovascular disease scenario, patients with reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction show an increased risk of sudden death related to cardiac arrhythmia. The use of Cardiovascular Implantable Electronic Devices (CIED), such as Implantable Cardioverter Defibrillators (ICDs), has shown to be beneficial in improving survival rates in this patient profile. 1 The Cardiac Resynchronization Therapy (CRT) also demonstrates benefits in reducing hospitalization rates, improving ventricular function, as well as decreasing mortality in the context of heart failure (HF). 2,3 During the CIED implantation, according to the clinical indication, it is necessary to use one, two or even three intracardiac leads. In CRT, the difficulty in cannulating the coronary sinus, or the lack of an adequate venous branch for this purpose, tends to increase the surgical procedure complexity, which may be associated with greater morbidity in the follow-up after hospital discharge – a situation often attributed or confused with the underlying disease severity. Regardless of the implantation route used for left ventricular estimation, we know there are lead dislodgement and dysfunction rates of approximately 5% 4 after the surgery, and the presence of a higher number of leads makes the probability of this type of event occurrence even higher. On the other hand, unscheduled emergency visits related to CIED occur, not necessarily because of the leads, in up to 12% of patients undergoing this type of therapy. 4,5 Local data that assess the rate of unscheduled hospital visits related to the implants are limited to the southeast region, and there is no recent literature disclosing data from the southern region of the country. The present study aims to contribute to this issue. 491