Abstract: SA-PO1092
A Tragic Missed Opportunity: Leadless Cardiac Devices in Hemodialysis Patients
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Alagusundaramoorthy, Sayee Sundar, University of Wisconsin, Madison, Wisconsin, United States
- Gardezi, Ali I., University of Wisconsin, Madison, Wisconsin, United States
- Chan, Micah R., University of Wisconsin, Madison, Wisconsin, United States
Background
There is a frequent need for placement of cardiac implantable electronic devices (CIEDs) in hemodialysis patients. Placement of a CIED is associated with central vein stenosis, infections and access failure. Cardiac electrotherapy has advanced significantly with the availability of s-ICDs and Leadless pacemakers. The goal of this study is to assess the effectiveness of these devices in patients.
Methods
We conducted a retrospective study of adult ESRD patients who underwent leadless cardiac device placement between January 2014 - September 2018.
Results
Among patients who underwent leadless device placement, 14 patients were on renal replacement therapy (15.38%). Mortality among these patients after leadless device placement was 33.3%. There were no episodes of bacteremia requiring long term antibiotics or extended hospitalization post device placement. Patients with AVF required interventions due to stenosis of their peripheral veins, however the access remained patent until the end of the follow-up period.
Conclusion
A small minority of patients on dialysis underwent leadless device placement. Theses devices are associated with lesser incidence of catheter related bacteremia and sustained access patency in patients. Consideration should be given to the placement of such devices in patients on or close to needing renal replacement therapy.
Access characteristics in patients pre and post leadless device implantation
| Venous Access for Hemodialysis | Tunneled Dialysis Catheter | Arterio-venous Fistula | Arterio-Venous Graft |
| At the time of Device placement | 58.33% (7) | 33.33% (4) | 8.33% (1) |
| Bacteremia prior to device placement requiring prolonged antibiotics and lead removal | 25% (42.85%) | 8.33% (25%) | 8.33% (100%) |
| Incidence of Central Venous stenosis | 8.33% (14.28%) | 8.33% (25%) | 0 |
| Need for intervention after device implantation | 0 | 33.33% (100%) | 0 |
| Bacteremia post leadless device placement | 0 | 16.67% (50%) | 0 |
| Access patency post device implantation | 58.33% (7) | 33.33 % (4) | 8.33% (1) |
| Mortality | 25% (42.85%) | 8.33% (25%) | 0 |