Postcardiac injury syndrome after cardiac implantable electronic device implantation
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Kevin Filbey1 · Farbod Sedaghat-Hamedani1,2 · Elham Kayvanpour1,2 · Panagiotis Xynogalos1 · Daniel Scherer1 · Benjamin Meder1,2 · Hugo A. Katus1,2 · Edgar Zitron1,2 1 2
Department of Medicine III, Universitätsklinikum Heidelberg, INF 410, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
© The Author(s) 2020
Postcardiac injury syndrome after cardiac implantable electronic device implantation
Electronic supplementary material The online version of this article (https://doi. org/10.1007/s00059-020-04910-6) contains supplementary material, which is available to authorized users.
Postcardiac injury syndrome (PCIS) is an inflammatory response to epicardial, myocardial, or endocardial injuries. It can follow cardiac surgery, myocardial infarction, trauma, intracardiac ablation, percutaneous coronary intervention, or implantation of cardiac implantable electronic device (CIED; [1–4]). The underlying pathogenesis is thought to be an autoimmune reaction directed toward the contractile cardiac proteins, which are exposed after cardiac injury. This leads to an inflammation of the pericardium that manifests itself in pericardial effusion (PE; [1, 5]). The most common cause of PCIS is cardiac surgery, with an incidence of approximately 15–30% [6]. The severity of the autoimmune reaction seems to correlate with the level of antiheart antibodies (AHAs; [5, 7]). It is unclear whether elevated levels of AHAs are the actual cause of PCIS or only an epiphenomenon [8]. A viral origin is also possible [9]. The exact incidence of PCIS after CIED implantation is unclear and has been estimated to be approximately 0.2–5% and Kevin Filbey and Farbod Sedaghat-Hamedani contributed equally to this paper.
might be related to implantation technique, lead tip position, and design [1, 10–13]. The incidence of PCIS in patients receiving CIED implantation via active fixation has been shown to be significantly higher than those with passive fixation [12]. Active fixation not only creates a greater injury, it also makes micro-perforation of the myocardium more likely. This causes a greater release of cardiac proteins and therefore a more severe immune response [10, 12, 14]. Being a rare complication, the diagnosis of PCIS remains difficult. Clinical symptoms and signs such as dyspnea, thoracic pain, fever, pericardial friction, and PE, in addition to elevated inflammatory parameters (erythrocyte sedimentation rate [ESR], C-reactive protein (CRP), and leukocytes), are the most widely reported symptoms and findings in PCIS [15–17]. In this large retrospective study, we evaluated the incidence and possible risk factors leading to PCIS after CIED implantation via active lead fixation.
Material and methods This retrospective study was performed after approval of the institutional ethics committee of the University of Heidelberg and in accordance with national ethical standards. We performed a singlecenter retrospective study and included all patients who received a CIED at the University Hospital in Heidelberg between 200
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