title: Malfunction of implantable cardioverter defibrillators placed by a nonthoracotomy approach: frequency of malfunction and value of chest radiography in determining cause.
abstract: OBJECTIVE
  The purpose of this study was to determine the frequency of system malfunction in patients with nonthoracotomy implantable cardioverter defibrillators and to assess the role of chest radiography in detecting and determining the cause of malfunction.
  
  
  METHODS
  The study population consisted of 300 consecutive patients in whom implantable cardioverter defibrillators were implanted using an initial nonthoracotomy approach between September 1990 and October 1994. Transvenous electrodes were placed via the subclavian or cephalic vein under local anesthetic. Intraoperative testing, pulse generator implantation, and, if necessary, subcutaneous patch or extrapericardial patch placement via thoracotomy were done in the operating room under general anesthetic. Follow-up consisted of routine device interrogation every 2-3 months and annual chest radiography. Chest radiographs were obtained more often if patients were symptomatic or if results of device interrogation were abnormal.
  
  
  RESULTS
  Patients were followed up for a mean +/- SD of 19 +/- 14 months following implantation. Implantable cardioverter-defibrillator malfunction occurred in 17 patients (6%) during the follow-up period. Of these, 12 (71%) had component abnormalities on chest radiographs. Patients with radiographically apparent implantable cardioverter-defibrillator abnormalities presented in two discrete time periods after device implantation, early (mean, 35 +/- 14 days) and late (mean, 18 +/- 5 months).
  
  
  CONCLUSIONS
  Malfunction of nonthoracotomy implantable cardioverter-defibrillator systems develops infrequently after device implantation. In most cases, the cause can be identified on chest radiographs.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Drucker
authors.forename: R
authors.initials: R
authors.lastname: Brooks
authors.forename: H
authors.initials: H
authors.lastname: Garan
authors.forename: M O
authors.initials: MO
authors.lastname: Sweeney
authors.forename: J M
authors.initials: JM
authors.lastname: Ruskin
authors.forename: B A
authors.initials: BA
authors.lastname: McGovern
authors.forename: S W
authors.initials: SW
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D013908:Thoracotomy; D013997:Time Factors