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  • Cardiac Tamponade on Rise After Pacemaker Implantation Still, questions about how clinically relevant the increase is

    Patients getting permanent pacemakers became increasingly burdened by cardiac tamponade, a retrospective study found.


    The condition occurred at a rate of 0.28% among patients receiving permanent pacemakers between 2008 and 2012, according to Alfonso H. Waller, MD, director of advanced cardiac imaging at Rutgers New Jersey Medical School in Newark, and colleagues.


    In the study, published online in JACC: Clinical Electrophysiology, the team reported that in-hospital tamponade grew by 35% during that period (0.26% in 2008 versus 0.35% in 2012). This 5-year span coincided with more in-hospital deaths for patients who developed tamponade (5.2% versus 7.1%).


    The authors noted that the odds were stacked against the following groups of patients, with a greater likelihood of cardiac tamponade in:


    • Women (OR 1.23, 95% CI 1.04-1.54);
    • Recipients of dual chamber pacemakers (OR 1.68, 95% CI 1.17-2.41); and
    • Those with chronic liver disease (OR 3.18, 95% CI 1.92-5.64).


    "These findings provide insight into the increasing burden of tamponade among patients receiving permanent pacemaker devices and helps physicians to identify patients at highest risk for development of in-hospital tamponade following the procedure," Waller and colleagues concluded.


    The reported rise in effusion rates is "worrisome," although the absolute increase in the rate is "really very small," commented Vivek Reddy, MD, of The Mount Sinai Hospital in New York, who was not part of the investigation. "I'm not sure it impacts our practice that much."


    Even so, "it was important that effusions were associated with a substantial increase in mortality," Reddy told MedPage Today. "While not proven to be causative, it is certainly suggestive. This again highlights the importance of trying to minimize the occurrence of effusions in clinical practice."


    Also asked for his opinion, Richard Lange, MD, MBA, president of the Texas Tech University Health Sciences Center in El Paso and dean of the Paul L. Foster School of Medicine, agreed that the incidence of in-hospital cardiac tamponade "is still low and not clinically significant.


    "It would be helpful to know the number of single-chamber, dual-chamber, and biventricular pacers placed each year to ascertain whether this influenced the rising incidence of in-hospital cardiac tamponade," he told MedPage Today.

    Reddy suggested other variables -- such as anticoagulation status and increased stenting -- that may have contributed to the increased rate over time.


    Waller's group utilized the Nationwide Inpatient Sample for their study, accessing the records of 922,549 patients who received permanent pacemakers between 2008 and 2012.


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