A New Predictor for Patients with Cardiac  Implantable Electronic Device in Iatrogenic  Pneumothorax: The Clavicle Length Index

Abdullah Orhan Demirtaş; Yahya Kemal İçen; Esra Dönmez; İbrahim Ethem Özsoy; Hasan Koca; Fadime Karataş; Mevlüt Koç

doi:10.5152/EurJTher.2019.19017

Authors

Abdullah Orhan Demirtaş Clinic of Cardiology, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0003-4768-0536
Yahya Kemal İçen Clinic of Cardiology, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0003-0070-5281
Esra Dönmez Clinic of Cardiology, Konya Numune Training and Research Hospital, Konya https://orcid.org/0000-0003-4484-4259
İbrahim Ethem Özsoy Clinic of Chest Surgery, University of Health Sciences Kayseri Training and Research Hospital, Kayseri https://orcid.org/0000-0003-2722-5309
Hasan Koca Clinic of Cardiology, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0002-6232-4567
Fadime Karataş Clinic of Cardiology, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0002-3573-7593
Mevlüt Koç Clinic of Cardiology, University of Health Sciences Adana Health Practice and Research Center, Adana https://orcid.org/0000-0002-3000-4200

DOI:

https://doi.org/10.5152/EurJTher.2019.19017

Keywords:

Cardiac device, clavicle, length index, pneumothorax

Abstract

Objective: Pneumothorax (PTX) is a complication that occurs while placing cardiac implantable electronic devices (CIED) in the thorax. In the literature, no clear relationship has been identified between the patient’s anatomic structure and the occurrence of PTX. We aim to investigate whether there is a relationship between PTX and anatomic structure in patients with CIED.
Methods: We retrospectively included 1602 patients in whom CIED had been placed for any reason between June 2008 and June 2018. The proximal clavicle tip, middle point, distal tip, and angulus mandible were marked and distances between these points were measured. The ratio between body mass index (BMI) and clavicle length was obtained (clavicle length index).
Results: We included 1568 (97.8%) patients without PTX and 34 (2.2%) patients with PTX in our study. The length of the clavicle and the distance between angulus mandible and clavicle middle point, angulus mandible, and clavicle distal tip significantly decreased, while the clavicle length index (CLI) significantly increased in PTX patients. The distance between angulus mandible and clavicle distal tip (OR: 0.811) and CLI (OR: 8.014) were determined to be independent predictors for pneumothorax. When the cut-off value for CLI was taken as 1.67, it was observed that PTX was predicted with 70% sensitivity and 62% specificity.
Conclusion: The operator can predict the PTX in the patient by measuring the length of the clavicle and the BMI.

Metrics

Metrics Loading ...

References

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281-329.

Van der Heijden AC, Borleffs CJ, Buiten MS, Thijssen J, van Rees JB, Cannegieter SC, et al. The clinical course of patients with implantable defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications. Heart Rhythm 2015; 12: 1169-76.

Poole JE, Gleva MJ, Mela T, Chung MK, Uslan DZ, Borge R, at al. Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation 2010; 122: 1553-61.

Kirkfeldt RE, Johansen JB, Nohr EA, Moller M, Arnsbo P, Nielsen JC. Pneumothorax in cardiac pacing: a population-based cohort study of 28,860 Danish patients. Europace 2012; 14: 1132-8.

Ogunbayo GO, Charnigo R, Darrat Y, Morales G, Kotter J, Olorunfemi O, et al. Incidence, predictors, and outcomes associated with pneumothorax during cardiac electronic device implantation: A 16-year review in over 3.7 million patients. Heart Rhythm 2017; 14: 1764-70.

Van Rees JB, de Bie MK, Thijssen J, Borleffs CJ, Schalij MJ, van Erven L. Implantation-related complications of implantable cardioverterd fibrillators and cardiac resynchronization therapy devices: A systematic review of randomized clinical trials. J Am Coll Cardiol 2011; 58: 995-1000.

Chauhan A, Grace AA, Newell SA, Stone DL, Shapiro LM, Schofield PM, et al. Early complications after dual chamber versus single chamber pacemaker implantation. Pacing Clin Electrophysiol 1994; 17: 2012-5.

Huang TW, Cheng YL, Tzao C, Hung C, Hsu HH, Chen JC, et al. Factors related to primary bilateral spontaneous pneumothorax. Thorac Cardiovasc Surg 2007; 55: 310-2.

Chiu CY, Chen TP, Wang CJ, Tsai MH, Wong KS. Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients. Eur J Pediatr 2014; 173: 1483-90.

Byrd CL. Clinical experience with the extrathoracic introducer insertion technique. Pacing Clin Electrophysiol 1993; 16: 1781-4.

Ellenbogen KA, Lau C, Wilkoff BL, Kay GN, Lau CP. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy, 4th Ed. Philadelphia, PA, Saunders, 2011.

Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologist and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract 2016; 22(Suppl 3): 1-203.

Ogata S, Uhthoff HK. The early development and ossification of the human clavicle--an embryologic study. Acta Orthop Scand 1990; 61: 330-4.

Kotter J, Lolay G, Charnigo R, Leung S, McKibbin C, Sousa M, et al. Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation. Pacing Clin Electrophysiol 2016; 39: 985-91.

Lin YS, Hung SP, Chen PR, Yang CH, Wo HT, Chang PC, et al. Risk factors influencing complications of cardiac implantable electronic device implantation: infection, pneumothorax and heart perforation: a nationwide population-based cohort study. Medicine (Baltimore) 2014; 93: e213.