Complications Research On Cardiovascular Implantable Electronic Devices And Its Clinical Observation In The Treatment Of Chronic Heart Failure

Cardiovascular implantable electronic devices (CIED) including permanentpacemaker (PPM), implantable cardioverter defibrillator (ICD), cardiacresynchronization therapy(CRT), have been widely used in clinical treatment for manyyears. PPM is often used in bradycardia Atrioventricular block and refractory atrialfibrillation, ICD is used in life-threatening ventricular tachycardia and ventricularfibrillation,CRT is recommended for chronic congestive heart failure(CHF). There is nodoubt for the treatment effects of pacemaker.However, the complication is still an openquestion. So it is important to study the risk factors of post-operative complication in orderto guide doctors to treat patients and nursing. CRT, which is an effective treatment for CHF, can improve the symptoms of patients,increase the endurence in exercises andreduce the mortality. In this article, we aim to investigate the mechanism and discusspotential problems by observing the clinical effects of CRT in treating CHF.Experiment1Analysis of Complications in Patients with Permanent PacemakersImplantationObjective:We studied446patients with permanent pacemaker from2006to2011in departmentof cardiology, Tangdu Hospital. According to the severity classification system ofcomlication(2009), system analysis was carried out on the complications. We used χ2testand Logistic analysis to find risk factors of permanent pacemaker implantation. Becauseof no obvious relationship among the various complications, we hope to find the higherincidence of the risk factors.Methods:1. We retrospectively analyzed446cases’ clinical data of permanent cardiacpacemaker implantation from June2006to July2011. Demographic information wascollected from the medical record of each patient, including age, gender, diagnosis,pacemaker types, preoperative blood test characters, intraoperative test parameters,programmed data and all kinds of complications.2. According to the severity classification system of complication (2009), wemainly studied the following complications such as hematoma in pocket, infection,electrode dislocation, pacemaker syndrome, and other special types of complications.Sometimes, one patients with pacemaker implantation had complications more than oncein different periods. Then it was accounted for only once, but in the following analysis ofvarious complications they were analyzed.3. We used SPSS16.0to analyze the data. Enumeration data was showed by numberand percentage. Measurement data of normal distribution was showed by mean and standard deviation,while median and quartile was applied for measurement data ofabnormal distribution. χ2test was applied and p-value less than0.05could be thought aspotential risk factors. If Logistic regression method was used, p-value less than0.05couldbe thought the possibility of risk factors.Results:1. Patients’ basic information: We chose446patients(male236, female210) withpermanent pacemaker implantation and their average age is56.7±18.4. Before operation,their number of WBC is5.16±1.26×10E9/L, PLT216.23±56.95×10E9/L. The value of PTis11.56±1.12S, APTT28.27±5.14S. There are179patients with sick sinus syndrome(40.1%),127with III Atrioventricular block(28.4%),27with Ⅱ°2atrioventricularblock(6%),3with double knot lesions(0.67%),28with slow-fast syndrome(6.2%),58with pacemaker replacement(13%),20with dilated cardiomyopathy(4.4%),2withhypertrophic obstructive cardiomyopathy(0.44%),1with ischemiccardiomyopathy(0.22%),1with ventricular tachycardia (0.22%). The form of pacemakerincluded VVI(80patients,17.9%), DDD/DDDR(344patients,77.1%), CRT(21patients,4.7%), ICD(1patients,0.22%).2. Complication:21of the total patients(446) with pacemaker implantation sufferedfrom complication and the incidence is4.7%. They included3cases with VVI (14.2%),11cases with DDD(52.3%),7cases with DDDR(33.8%). Among this, hematoma inpocket and infection were common,33.3%and23.8%respectively.3.Statistics show that age is a potential risk fator for the complication of pacemakerimplantation, but gender has no relation to it. The number of white blood cells beforeoperation has relation to infection. The lower the number is,the higher incidence ofinfection will be. The number of blood platelet has relation to hematoma in pocket. If thenumber of blood platelet is lower before operation, the higher incidence of hematoma willbe got. So as to the value of PT and APTT, the higher before operation, the higherincidence of hematoma will be.Conclusion:By studying the data of patients with permanent pacemaker implantation during June 2006to July2011in department of cardiology, Tangdu Hospital, we came to thefollowing conclusion. First,4.7%of the total patients after pacemaker implantationsuffered from complication including33.3%infection and23.8%hematoma in pocket.Second, χ2test showed that age, especially over60years old, is a potential risk fator forthe complication of pacemaker implantation, but gender has no relation to it. Logisticshowed that the lower white blood cells before operation, the more infection would beafter operation. Hematoma in pocket had relation to the lower number of blood platelet,higher in the value of PT and APTT.Experiment2Cardiac Resynchronization Therapy for Treatment of Chronic HeartFailureObjective:In this study, we collect43patients with chronic heart failure, who were treatedwith CRT in department of cardiology, Tangdu Hospital,from July2010to July2012.By observing the clinical effect of cardiac resynchronization therapy for chronic heartfailure, we aim to explore the mechanism and current problems of CRT.Methods:We treated43patients with CRT pacemaker implantation including26males and17females, whose ages range from14to79years old and average age is52.5±9.3years old.In these cases, there are34patients with dilated cardiomyopathy,8ones with ischemiccardiomyopathy, one person with hypertensive cardiomyopathy,4patients withimplantable cardioverter defibrillator (ICD). Clinical symptoms and signs,6MWT, QRSduration, EF value, left ventricular end-diastolic diameter, synchronism difference of leftand right ventricles, BNP were observed before operation as well as three and six monthsafter operation, to assess the clinical effect of cardiac resynchronization therapy. We usedSPSS13.0for statistical analysis and the data was shown with x±s，comparison withpaired test.Results:After3-6months follow-up, one patients died of sudden death and the others’ cardiac function was significantly improved. After operation, they showed further in6minwalking, improvement in symptoms and quality of life, better LVEF and so on. Nocomplications such as hemorrhage, hematoma and infection were found and no electrodewires were found dislocated.Conclusion:Cardiac resynchronization therapy can obviously improve the cardiac dysfunction ofpatients with chronic heart failure.