title: Cardiac implantable electronic devices in tracheotomized muscular dystrophy patients: Safety and risks.
abstract: OBJECTIVE
  Muscular dystrophies are genetic muscle disorders, in which heart involvement and chronic respiratory impairment affect survival. Cardiac conduction disturbances require implantable cardiac pacemaker. Implantable defibrillators may also be necessary to prevent cardiac sudden death. The safety and risk of cardiac electronic devices' implantation are not known in patients with muscular dystrophy. We aimed to assess the risks related to cardiac implantable electronic devices (CIED) in muscular dystrophy patients ventilated by tracheostomy.
  
  
  METHODS
  We reviewed all medical charts of neuromuscular patients and identified all CIED implantations of pacemakers (PM) or defibrillators (ICD) in patients ventilated using tracheostomy.
  
  
  RESULTS
  Twelve device implantations were included, performed in 9 patients (5 DMD, 1 Becker muscular dystrophy and 3 DM1). Mean age was 39.9years±13.0. All patients were wheel-chair bound and tracheotomized. Six pacemakers (PM) and 6 cardiac resynchronization (CRT) devices, including 2 defibrillators (CRT-D) were implanted. Following device implantation, two patients had a pneumothorax and one died from severe heart failure after an unsuccessful CRT implant attempt. Follow-up lasted up to 8years (mean 2.6±2.9years), during which one patient presented a PM pocket infection, requiring PM explantation and epicardial reimplantation.
  
  
  CONCLUSIONS
  We found a high prevalence of early complications (16.6% pneumothorax) after CIED implantation and an acceptable long-term infectious risk (8.3%). These results highlight the feasibility of CIED implantation in tracheotomized patients with muscular dystrophies and the need for a particular caution in the management of these patients during invasive procedures. ClinicalTrials.gov (identifier: NCT02501083).
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France; Clinical Investigation Center CIC 14.29, INSERM, Garches, France. Electronic address: abdallah.fayssoil@aphp.fr.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Fayssoil
authors.affiliation: Rhythmology Unit, Clinique Ambroise Paré, Neuilly sur Seine, France; Cardiology Unit, Cochin University Hospital, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lazarus
authors.affiliation: Cardiology Unit, Cochin University Hospital, Paris, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Wahbi
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France.
authors.forename: Adam
authors.initials: A
authors.lastname: Ogna
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Nardi
authors.affiliation: Physiology Department, Raymond Poincare Hospital, Garches, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lofaso
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Clair
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France; Clinical Investigation Center CIC 14.29, INSERM, Garches, France.
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.affiliation: Intensive Care Unit, GNHM Neuromuscular Center, Raymond Poincare Hospital, Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009136:Muscular Dystrophies / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014140:Tracheotomy; D055815:Young Adult
keywords: Implantable cardiac defibrillator; Infection; Muscular dystrophy; Pacemaker; Pneumothorax; Tracheotomy