title: Mechanical complications after implantation of multiple-lead nonthoracotomy defibrillator systems: implications for management and future system design.
abstract: Nonthoracotomy lead system (NTL) implantable cardioverter defibrillators (ICDs) provide excellent protection against sudden death from ventricular tachyarrhythmias. However, these devices have unique mechanical complications and management issues. We reviewed the major complications occurring in 159 patients who underwent attempted implantation of a multilead NTL system. Successful implantation was obtained in 98% of patients. Two-year, all-cause actuarial survival on an intention-to-treat basis was 94%. Major complications occurred in 28 (17.6%) patients over a follow-up period of 21 +/- 10 months. Complications included 11 (6.9%) lead dislodgements, 10 (5.7%) lead fractures in 9 patients, 2 (1.3%) pocket infections, 1 frozen shoulder, 1 right ventricular perforation, 1 pneumothorax, 1 bleed requiring transfusion, 1 thromboembolism, and 1 "twiddle"-induced torsion of leads. Most of the lead dislodgements and fractures were identified by routine x-ray surveillance. Single-lead systems may significantly reduce complication rates in the future and maintain excellent survival rates.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle 98195, USA.
authors.forename: G K
authors.initials: GK
authors.lastname: Jones
authors.forename: G H
authors.initials: GH
authors.lastname: Bardy
authors.forename: P J
authors.initials: PJ
authors.lastname: Kudenchuk
authors.forename: J E
authors.initials: JE
authors.lastname: Poole
authors.forename: G L
authors.initials: GL
authors.lastname: Dolack
authors.forename: C
authors.initials: C
authors.lastname: Troutman
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.forename: G
authors.initials: G
authors.lastname: Johnson
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000628:therapy; D013908:Thoracotomy; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy