[An unusual series of complications in therapy with implantable cardioverter-defibrillator].
A 48-year-old man with dilative cardiomyopathy and a history of resuscitation due to ventricular fibrillation received an implantable cardioverter-defibrillator (ICD) with epicardial sensing and defibrillation electrodes in March 1990. An early battery depletion due to increased electrical leakage of a filter capacitor necessitated a generator exchange in July 1990. Subsequent inappropriate discharges occurred, but no underlying cause could be documented by history, clinical examination, Holter monitoring, and beepograms. Only 3 months later was it possible to demonstrate oversensing by repeated beepograms, and a new generator and transvenous sensing electrode were implanted in October 1991. Four months later, inappropriate shocks were suspected again. Once more, history, clinical examination, Holter monitoring, and beepograms were without pathological result. At follow-up, repeated beepograms during exercise demonstrated an oversensing, and an insulation defect of the newly implanted sensing electrode close to the edge of the generator could be documented on x-ray. Since replacement of generator and sensing electrode in July 1992 the patient is doing well. He received two appropriate shocks which were associated with presyncope. ICD therapy is very complex and therefore should only be performed in centers providing the necessary personal, apparative and logistic conditions.
Peters
W
W
Medizinische Klinik, Universität Würzburg.
Hopp
H
H
Bauer
W R
WR
Kowallik
P
P
Meesmann
M
M
D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D004566:Electrodes; D004868:Equipment Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
Eine ungewöhnliche Serie von Komplikationen bei der Therapie mittels implantierbarem Kardioverter-Defibrillator.