Is Antiarrhythmia Device Implantation Safe Under Dual Antiplatelet Therapy?

Henryk Dreger, M.D.; Andrea Grohmann, M.D.; Hansjürgen Bondke, M.D.; Boris Gast, M.D.; Gert Baumann, M.D.; Christoph Melzer, M.D.


Pacing Clin Electrophysiol. 2010;33(4):394-399. 

In This Article

Abstract and Introduction


Background: Device implantations in patients on dual antiplatelet-therapy (DA-therapy) continue to rise. The aim of our study was to compile and analyze data on complications of antiarrhythmia device implantation under DA-therapy.
Methods: We prospectively collected data on all device implantations in our department from January 2008 until February 2009. The control group was comprised of patients on acetylsalicylic acid alone or no antiplatelet medication at all (318 subjects). The DA-therapy group consisted of 109 patients of whom 71 were analyzed retrospectively (implantations from 2002 to 2007).
Results: Procedure times were significantly longer in DA-therapy patients receiving a pacemaker for the first time. In contrast, procedure times did not differ significantly between the two study groups for implantable cardioverter defibrillator (ICD) implantations and for pacemaker replacements. Fluid losses via drainage systems and drainage times were significantly increased in the DA-therapy group as compared with the control group after pacemaker but not after ICD implantations. Importantly, there were no significant differences in complication rates, particularly the hematoma rate, between the DA-therapy and the control group.
Conclusions: When drainage systems are used, antiarrhythmia device implantation is safe and can be performed without significantly increased risk of clinically relevant hematoma in patients on continued DA-therapy. (PACE 2010; 394–399)


The increasing use of stents in coronary interventions, particularly drug-eluting stents,[1] and the subsequent need for dual antiplatelet-therapy (DA-therapy)[2] result in rising numbers of patients on DA-therapy, consisting of acetylsalicylic acid (ASA) and thienopyridines (ticlopidine/clopidogrel), at the time of antiarrhythmia device implantation.[3] Currently, there are no recommendations regarding the implantation of antiarrhythmia devices under DA-therapy.[4–6] Generally, interruption of DA-therapy is associated with an increase in stent thrombosis.[7] Wiegand et al.[3] reported an almost 10 times higher pocket bleeding rate (intraoperative bleeding or pocket hematoma) in patients on DA-therapy compared with patients without any anticoagulation therapy (21.7% vs 2.5%).[3] Considering the high mortality rate of an acute stent thrombosis (i.e., 30%),[8] it is not acceptable to discontinue DA-therapy for antiarrhythmia device implantation.

The goal of our study was to analyze the complications associated with antiarrhythmia device implantation under DA-therapy in our center.