Rutgers New Jersey Medical School West Orange, New Jersey
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.
