B0440 - Do Patients With ICDs or Pacemakers Develop Device Malfunction After ERCP?

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Ayham Khrais, DO

Rutgers New Jersey Medical School
West Orange, New Jersey

Ayham Khrais, DO¹, Mohamad Aghaie Meybodi, MD², Aaron Kahlam, MD², Sushil Ahlawat, MD²
¹Rutgers New Jersey Medical School, West Orange, NJ; ²Rutgers New Jersey Medical School, Newark, NJ

Introduction: Sphincterotomy in endoscopic retrograde cholangiopancreatography (ERCP) involves the use of electrocautery to access the biliary tree. There is a theoretical risk of electromagnetic interference (EMI) in patients with implantable cardioverter-defibrillators (ICD) or pacemakers (PM) who undergo electrosurgery. Studies found the EMI risk to be minimal, yet they utilized small sample sizes. Our goal is to assess potential risk of EMI in patients with ICDs or PMs undergoing ERCP.

Methods: The National Inpatient Sample (NIS) was used to identify hospitalized patients with ICDs/PMs and gallstones, stratified based on whether they received ERCP, from 2001 to 2013 via International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes. Primary outcomes consisted of mortality, length of stay, and hospitalization charges. Secondary outcomes included complications of AICD/PM malfunction (ICD discharge and syncope), different arrhythmias, cardiac arrest, and various degrees of heart block. Chi-squared tests and independent t-tests were performed to assess categorical and continuous data, respectively. Multiple logistic regression was used to control for confounders.

Results: The non-ERCP group had 40,630 individuals while the ERCP group had 6,250. Both non-ERCP & ERCP groups were mostly male (59.51% versus 57.14%) and Caucasian (79.08% versus 82.49%). Members of the ERCP group were older (78.22±11.129 years versus 75.45±12.203 years; adjusted p< 0.05). Mortality was higher in the non-ERCP group (2.71% versus 2.06%; adjusted p< 0.05). LOS (7.28±5.774 days versus 5.54±5.102 days; p< 0.05) and total charges ($55,305.18±55,500.141 versus $36,701.06±46,133.869; p< 0.05) were higher in the ERCP group. The non-ERCP group had higher rates of syncope (1.28% versus 0.69%; adjusted p< 0.05), unspecified cardiac dysrhythmia (0.89% versus 0.54%; adjusted p< 0.05) and left bundle branch block (LBBB; 1.43% versus 1.04%; p< 0.05). Differences in rates of other arrhythmias and heart block were statistically insignificant.

Discussion: This study found that ICD/PM patients with gallstones who underwent ERCP had mostly equal rates of arrhythmias and heart block as the non-ERCP group, however the latter had higher rates of syncope and mortality. This could be due to the medical optimization patients undergo prior to ERCP. These patients are closely observed and managed with frequent follow-ups. Further prospective studies are needed to elucidate the potential for EMI in those undergoing ERCP.

			Non-ERCP group				ERCP group					OR		CI	p-value		AOR	ACI		Adjusted p-value
			Percentage		n		Percentage			n
Mortality			2.71		1,101		2.06			129		0.757		0.629-0.91	< 0.05		0.734	0.606-0.89		< 0.05
Complete AV block			0.70		283		0.77			48		1.103		0.812-1.5	0.53		0.983	0.703-1.374		0.918
1^st degree AV block			0.46		187		0.35			22		0.764		0.491-1.189	0.232		0.866	0.554-1.352		0.526
Other 2^nd degree AV block			0.14		57		0.24			15		1.712		0.969-3.026	0.061		1.663	0.921-3.001		0.092
Left BBB			1.43		582		1.04			65		0.723		0.559-0.936	< 0.05		0.715	0.546-0.935		< 0.05
Right BBB			0.88		357		0.93			58		1.057		0.8-1.396	0.698		0.877	0.71-1.083		0.224
Syncope			1.28		520		0.69			43		0.534		0.391-0.73	< 0.05		0.543	0.394-0.748		< 0.05
ICD discharge			0.06		23		0.03			2		0.565		0.133-2.398	0.433		0.813	0.188-3.521		0.782
Paroxysmal V Tach			3.62		1,471		2.86			179		0.785		0.671-0.919	< 0.05		0.858	0.727-1.012		0.069
VFib/VFlutter			0.28		114		0.3			19		1.084		0.666-1.763	0.746		1.059	0.624-1.797		0.832
Cardiac arrest			0.44		179		0.37			23		0.835		0.54-1.29	0.415		0.925	0.591-1.449		0.735
Cardiac dysrhythmia, unspecified			0.89		362		0.54			34		0.608		0.428-0.866	< 0.05		0.668	0.461-0.969		< 0.05
AFib/AFlutter			37.76		15,341		40.03			2,502		1.1		1.042-1.162	< 0.05		1.037	0.978-1.1		0.219
Premature Beats			0.63		258		0.528			33		0.831		0.578-1.195	0.316		0.926	0.639-1.344		0.687
Sex at birth	Female		40.49		16,448		42.86			2,679		1.103		1.045-1.164	< 0.05		1.102	1.04-1.167		< 0.05
	Male		59.51		24,179		57.14			3,571
Race	Caucasian		79.08		28,024		82.49			4,554					< 0.05
	Black		8.69		3,080		4.64			256
	Hispanic		7.68		2,722		8.2			453
	Asian or Pacific Islander		2.09		742		2.46			136
	Native American		0.39		138		0.33			18
	Other		2.07		733		1.88			104
		Non-ERCP group						ERCP group					Mean difference			CI			p-value
		Mean		SD		SE Mean		Mean	SD		SE Mean
Age at admission (years)		75.45		12.203		0.061		78.22	11.129		0.141		-1.763±0.164			-2.085 to -1.442			< 0.05
LOS (days)		5.54		5.102		0.025		7.28	5.774		0.073		-1.737±0.071			-1.875 to -1.599			< 0.05
Total charges (USD)		36,701.06		46,133.869		230.58		55,305.18	55,500.141		707.539		-18,604.115 ±650.266			-19,878.646 to -20,062.883			< 0.05

Table: Table 1 Demographics, Primary and Secondary Outcomes in Patients Undergoing ERCP with Known Gallstones With and Without an ICD/PM.

ERCP: endoscopic retrograde cholangiopancreatography; n: sample size; OR: odds ratio; CI: 95% confidence interval; AOR: adjusted odds ratio; ACI: adjusted confidence interval; AV: atrioventricular; BBB: bundle branch block; V Tach: ventricular tachycardia; VFib: ventricular fibrillation; VFlutter: ventricular flutter; AFib: atrial fibrillation; AFlutter: atrial flutter; AV: atrioventricular; SD: standard deviation; SE: standard error; USD: US dollars; LOS: length of stay.

Disclosures:

Ayham Khrais indicated no relevant financial relationships.

Mohamad Aghaie Meybodi indicated no relevant financial relationships.

Aaron Kahlam indicated no relevant financial relationships.

Sushil Ahlawat indicated no relevant financial relationships.

Ayham Khrais, DO¹, Mohamad Aghaie Meybodi, MD², Aaron Kahlam, MD², Sushil Ahlawat, MD². B0440 - Do Patients With ICDs or Pacemakers Develop Device Malfunction After ERCP?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.