Characterization of a New Clinical Phenomena: Shock Following Cardiac Implantable Electronic Device Extraction

Introduction: Cardiovascular implantable electronic device (CIED) extraction is a complex procedure associated with morbidity and mortality. We observed that in some cases patients undergo extraction without associated complications but develop shock during the first day necessitating vasopressor support. We sought to characterize and evaluate predictors leading to this clinical condition.

Methods: We retrospectively analyzed data of 221 consecutive patients who underwent CIED extraction between 2010-2015. Ten Patients were excluded since they were lost t3o follow up. The primary end point was shock within 1 day post procedure, defined as persistence hypotension with a drop of ≥ 30% in the mean arterial pressure for at least 30 min, mediating the need for vasopressors. Patients who were hemodynamically unstable during the extraction procedure were excluded. Baseline characteristics and mortality were compared between the 2 groups. Major adverse events were defined as: intubation, sepsis, worsening of renal function, and death.

Results: Twenty one patients (10%) (group A) fulfilled the definition of primary endpoint. Reasons for shock were a bout of sepsis (38%) or no apparent cause (62%). Patients in group A had significantly lower GFR (median eGFR 53 vs. 72 ml/min respectively; P=0.001), and had more signs of systemic infection prior to extraction {fever, bacteremia and leukocytosis; P

Conclusions: We describe a new clinical phenomena of shock occurring after CIED extraction but within 24 hours of the procedure. Despite vasopressor support complication and mortality rates remain high in this group. Whether patients with predictors for this condition at baseline should be treated aggressively is yet to be determined.