Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database

Muhammad Zia Khan; Yasar Sattar; Waleed Alruwaili; Sameh Nassar; Mohamed Alhajji; Bandar Alyami; Amanda T Nguyen; Joseph Neely; Zain Ul Abideen Asad; Siddharth Agarwal; Sameer Raina; Sudarshan Balla; Bao Nguyen; Dali Fan; Douglas Darden; Muhammad Bilal Munir

doi:10.1016/j.hroo.2024.02.004

Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database

Heart Rhythm O2. 2024 Feb 19;5(4):217-223. doi: 10.1016/j.hroo.2024.02.004. eCollection 2024 Apr.

Authors

Muhammad Zia Khan¹, Yasar Sattar¹, Waleed Alruwaili¹, Sameh Nassar¹, Mohamed Alhajji¹, Bandar Alyami¹, Amanda T Nguyen², Joseph Neely², Zain Ul Abideen Asad³, Siddharth Agarwal³, Sameer Raina⁴, Sudarshan Balla¹, Bao Nguyen², Dali Fan², Douglas Darden⁵, Muhammad Bilal Munir²

Affiliations

¹ Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
² Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California.
³ Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma.
⁴ Division of Cardiology, Stanford University, Stanford, California.
⁵ Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas.

Abstract

Background: Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation.

Objective: The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations.

Methods: The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed.

Results: Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation.

Conclusion: In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.

Keywords: Leadless pacemakers; Outcomes; Pericardial effusion; Predictors.