Background

Carcinoid heart disease (CHD) is a rare complication of hormonally active neuroendocrine tumors that often requires surgical intervention. Data on cardiac implantable electronic device (CIED) implantation in patients with CHD are limited.

Objective

The purpose of this study was to evaluate the experience of CIED implantation in patients with CHD.

Methods

Patients with a diagnosis of CHD and a CIED procedure from January 1, 1995, through June 1, 2020, were identified using a Mayo Clinic proprietary data retrieval tool. Retrospective review was performed to extract relevant data, which included indications for implant, procedural details, complications, and mortality.

Results

A total of 27 patients (55.6% male; mean age at device implant 65.6 ± 8.8 years) with cumulative follow-up of 75 patient-years (median 1.1 years; interquartile range 0.4–4.6 years) were included for analysis. The majority of implanted devices were dual-chamber permanent pacemakers (63%). Among all CHD patients who underwent any cardiac surgery, the incidence of CIED implantation was 12%. The most common indication for implantation was high-grade heart block (66.7%). Device implant complication rates were modest (14.8%). No patient suffered carcinoid crisis during implantation, and there was no periimplant mortality. Median time from implant to death was 2.5 years, with 1-year mortality of 15%.

Conclusion

CHD is a morbid condition, and surgical valve intervention carries associated risks, particularly a high requirement for postoperative pacing needs. Our data suggest that CIED implantation can be performed relatively safely. Clinicians must be aware of the relevant carcinoid physiology and take appropriate precautions to mitigate risks.

中文翻译：

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类癌心脏病患者心脏植入电子设备的结果和围手术期管理

背景

类癌性心脏病 (CHD) 是激素活跃的神经内分泌肿瘤的罕见并发症，通常需要手术干预。CHD 患者心脏植入式电子设备 (CIED) 植入的数据有限。

客观的

本研究的目的是评估 CHD 患者植入 CIED 的经验。

方法

在 1995 年 1 月 1 日至 2020 年 6 月 1 日期间诊断为 CHD 并接受 CIED 程序的患者是使用 Mayo Clinic 专有数据检索工具确定的。进行回顾性审查以提取相关数据，其中包括植入物的适应症、手术细节、并发症和死亡率。

结果

共有 27 名患者（55.6% 男性；植入装置的平均年龄 65.6 ± 8.8 岁），累计随访 75 患者年（中位数 1.1 年；四分位距 0.4-4.6 年）被纳入分析。大多数植入装置是双腔永久性起搏器（63%）。在所有接受任何心脏手术的 CHD 患者中，CIED 植入的发生率为 12%。最常见的植入指征是高级别心脏传导阻滞（66.7%）。装置植入并发症发生率适中（14.8%）。无患者在种植过程中发生类癌危象，无种植体周围死亡。从植入到死亡的中位时间为 2.5 年，1 年死亡率为 15%。

结论

CHD 是一种病态疾病，外科瓣膜干预具有相关风险，尤其是对术后起搏需求的高要求。我们的数据表明 CIED 植入可以相对安全地进行。临床医生必须了解相关的类癌生理学，并采取适当的预防措施来降低风险。