Characteristics of Perioperative Brain Infarction in Cardiac Electrical Device Implantation

概要

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Background: Large numbers of patients with brady arrhythmias have atrial fibrillation (AF). At cardiac electric device implantation (CEDI), perioperative brain thromboembolism was sometimes problematic. The aim of this study was to determine the characteristics of perioperative brain infarction in CEDI. Methods and Results: We analyzed consecutive 1007 patients who underwent cardiac electrical device implantation/replacement in our hospital from January 2007 to December 2010 (61% newly implantation, 26% ICD/CRT-D, mean age 79.6±10). We defined brain infarction within two months from CEDI as perioperative. Four patients (0.4%) developed perioperative brain infarction, and all of them were newly implanted pacemaker. They were consisted with 2 (50%) sick sinus syndrome (SSS), 1 (25%) atrioventricular block (AV block) and 1 (25%) AF bradycardia. There were no cases of perioperative brain infarction in ICD/CRT-D implantation or pacemaker replacement. All of them had paroxysmal/chronic AF and their CHADS2 score were above 3. Two (2⁄4=50%) of them received anticoagulation therapy, however, none of them kept PT-INR within therapeutic window. Conclusion: To compare with cardiac electrical device replacement, perioperative brain infarction tended to occur in newly implantation of pacemaker. We should prepare from perioperative brain infarction in newly implantation of pacemaker with high CADS2 score.