Complications of Third-Generation Implantable Cardioverter Defibrillator Therapy |
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Authors: | WOLFRAM GRIMM,VOLKER MENZ,JÜ RGEN HOFFMANN,UWE TIMMANN,REINHARD FUNCK,RAINER MOOSDORF,BERNHARD MAISCH |
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Affiliation: | Department of Cardiology, Hospital of the Philipps-University of Marburg, Germany;Department of Cardiothoracic Surgery, Hospital of the Philipps-University of Marburg, Germany |
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Abstract: | To determine the incidence of complications of third-generation implantable cardioverter defibrillator (ICD) therapy, 144 patients were prospectively studied who underwent first implant of third-generation devices (i.e., ICD systems with biphasic shocks, ECC storage capability, and nonthoracotomy lead systems). During 21 ± 15 months of follow-up, 41 (28%) patients had one or more complications. No patient died perioperatively (30 days) and no ICD infection was observed during follow-up. Complications included bleeding or pocket hematoma (hemoglobin drop > 2 g/dL) in 5 (3%) patients, prolonged reversible ischemic neurological deficit in 1 (1%) patient, postoperative deep venous thrombosis of leg in 1 (1%) patient, pneumothorax in 2 (1%) patients, difficulty to defibrillate ventricular fibrillation intraoperatively in 2 (1%) patients, generator malfunction in 1 (1%) patient, arthritis of the shoulder in 3 (2%) patients, and allergic reaction to prophylactic antibiotics in 2 (1%) patients. A total of seven lead related complications were observed in six (4%) patients including endocardial lead migration in four (3%) patients. Twenty-three (16%) patients received inappropriate shocks for supraventricular tachyarrhythmias (n = 13), non-sustained ventricular tachycardia (VT) (n = 7), or myopotential oversensing (n = 3). We conclude that serious complications such as perioperative death or ICD infection are rare in patients with third-generation ICDs. Lead-related problems and inappropriate shocks during follow-up are the most frequent complications of third-generation ICD therapy. Recognition of these complications should promote advances in ICD technology and management strategies to avoid their recurrence. |
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Keywords: | implantable defibrillator complications inappropriate shocks |
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