Device therapy questionnaire - Arrhythmia Alliance



Device Therapy Questionnaire

The purpose of this survey is to identify current practice around the UK with regard to device implantation, specifically concentrating on the use of antibiotic prophylaxis and anticoagulation management. For the purposes of this survey please consider device implants as a generic group (i.e. do no differentiate bradytherapy vs. ICD vs. CRT) and that they are all implanted prepectorally. I appreciate your time is valuable so have tried to keep this as brief as possible, and am extremely grateful for your time in completing this questionnaire.

Region/Deanery:

Grade (SpR, Consultant etc.)

E mail address (optional, if you would like results of entire survey sent to you):

Type of referral centre: Secondary/Tertiary

Device types implanted in your hospital (please delete as appropriate): Brady devices/ICDs/CRT

Approximate number of all implants in your institution per year if known:

Q1. A 70 year old man with a mechanical mitral valve prosthesis needs a device implanted.

Do you routinely perform implant whilst patient continues taking warfarin: YES/NO

If yes, target INR range for procedure itself AND maximum INR at

which you will proceed; then go to question 2 please:

If no, then number of days warfarin stopped pre implant:

Do you use heparin pre implant to cover period without warfarin: YES/NO

If yes then IV unfractionated heparin (IV) or low molecular

weight heparin (LMWH): IV/LMWH

What is your threshold INR for implant (above which

implant would be deferred):

Post implantation:

After how many days do you restart warfarin (0 if restart on day of procedure):

Do you use heparin: YES/NO

If yes then IV unfractionated heparin or LMWH: IV/LMWH

How long after implant do you start heparin:

Q2. Given the same patient with a mechanical aortic valve prosthesis would this alter your management: YES/NO

If yes then please briefly state how:

Q3. 70 year old man with permanent AF (but low risk for thromboembolism) needs a device implanted.

Do you routinely perform implant whilst patient continues taking warfarin: YES/NO

If yes, target INR range for procedure itself AND maximum INR at

which you will proceed; then go to question 4 please:

If no, then number of days warfarin stopped pre implant:

Do you use heparin pre implant to cover period without warfarin: YES/NO

If yes then IV unfractionated heparin (IV) or low molecular

weight heparin (LMWH): IV/LMWH

What is your threshold INR for implant (above which

implant would be deferred):

Post implantation:

After how many days do you restart warfarin (0 if restart on day of procedure):

Do you use heparin: YES/NO

If yes then IV unfractionated heparin or LMWH: IV/LMWH

How long after implant do you start heparin:

Q4. Given the same patient with multiple risk factors for thromboembolism

and a previous TIA would this alter your management: YES/NO

If yes then please briefly state how:

Q5. A patient who needs a pacemaker implanted for symptomatic complete heart block is taking aspirin and clopidogrel after PCI done 2 months ago with drug-eluting stents.

Would you stop the clopidogrel before pacemaker implantation YES/NO

If no, then go to question 6 please

If yes, for how long (in days)

After how many days do you restart clopidogrel (0 if restart on day of procedure)

If the patient attended for the implant but had NOT stopped clopidogrel

would you still proceed with the implant that day YES/NO

Q6. A patient who needs a pacemaker implanted for symptomatic complete heart block is taking aspirin and clopidogrel after PCI done 6 months ago with drug-eluting stents.

Would you stop the clopidogrel before pacemaker implantation YES/NO

If no, then go to question 7 please

If yes, for how long (in days)

After how many days do you restart clopidogrel (0 if restart on day of procedure)

If the patient attended for the implant but had NOT stopped clopidogrel

would you still proceed with the implant that day YES/NO

Q7. Antibiotics

Do you routinely give antibiotic prophylaxis pre implant procedure: YES/NO

Does your practice differ between new implants vs. generator changes: YES/NO

Do any other factors influence your decision to give pre implant antibiotic prophylaxis and if so please briefly describe:

Do you routinely give gentamicin topically into the pocket: YES/NO

Does your practice differ between new implants vs. generator changes: YES/NO

Do any other factors influence your decision to give gentamicin topically into the pocket and if so please briefly describe:

Do you routinely give antibiotics after the implant procedure: YES/NO

If yes, what duration of antibiotics (in days):

Does your practice differ between new implants vs. generator changes: YES/NO

Do any other factors influence your decision to give antibiotics after the implant and if so please briefly describe:

Q8. Do you have local guidelines/protocols that your practice is based upon for:

Anticoagulation management (as in questions 1-6) YES/NO

Antibiotic management (as in question 7) YES/NO

Any other comments about any aspect of the questionnaire:

Please return to: Dr Kim Rajappan

By e mail: kim.rajappan@orh.nhs.uk

By normal post: Dr Kim Rajappan

Cardiac Department

John Radcliffe Hospital

Headley Way

Headington

Oxford OX3 9DU

By fax: 01865 221194

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