Background
Requests from the emergency department (ED) for cardiac implantable electronic device
(CIED) checks constitute a large workload for cardiac electrophysiology services.
We sought to determine the yield of, and clinical characteristics associated with,
clinically relevant (remarkable) issues from ED CIED checks.
Methods
Consecutive CIED checks from our ED over a 12-month period were studied. A remarkable
issue (RI) was defined as arrhythmia relating to the presentation or device/lead issue
requiring reprogramming or intervention. The association between the presenting complaint
and an RI was assessed using regression analysis. Multivariable regression model was
used to identify pre-specified patient-level characteristics that were predictive
of a RI.
Results
A RI was found in 28% (n=98) of 354 ED CIED checks for 306 patients (76±16 yrs, 59%
male). Most patients had no RI (n=224, 73%). One third of checks occurred after-hours
and these had a higher yield of RIs than those during routine clinic hours (35% vs
23%, p=0.018). Presenting with a perceived ICD shock was predictive of a RI (odds
ratio [OR] 6.0, 95% CI=1.8–20.0). Syncope/presyncope was five-fold less likely to
be predictive of a RI (OR 0.19, 95% CI=0.13–0.28) despite being the most common indication
for CIED check (51%, n=180 checks). Only history of AF was predictive of RI while
advancing age was predictive of not finding a RI.
Conclusion
Almost three-quarters of ED CIED checks did not yield any RI. Patient-reported ICD
shock and history of AF were predictive of RI, while syncope/presyncope was not. New
models of care especially during after-hours, may help to reduce the burden on cardiac
electrophysiology services and health care costs.
Central Figure
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 20, 2022
Accepted:
March 4,
2022
Received:
January 28,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
