title: Right atrial compression related to defibrillator patches.
abstract: Acceptable function of an internal defibrillator can be achieved with different patch orientations. For patients requiring defibrillator patches concomitant with a cardiac procedure requiring extracorporeal circulation, application of one of the patches within the pericardium adjacent to the right atrium has provided excellent defibrillation thresholds. We describe 4 such patients in whom a compressing thrombus subsequently developed between the patch and the atrium. The thrombus was small and asymptomatic in 1 patient, but caused localized tamponade requiring reexploration in 2 patients and a fatal superior vena caval obstruction in 1. The precise etiology of this serious complication remains unclear, but its occurrence argues against the application of intrapericardial defibrillator patches in this orientation.
authors.affiliation: Department of Cardiovascular Diseases, Mid-America Heart Institute of Saint Luke's Hospital, Kansas City, Missouri.
authors.forename: J M
authors.initials: JM
authors.lastname: Piehler
authors.forename: D A
authors.initials: DA
authors.lastname: Killen
authors.forename: A M
authors.initials: AM
authors.lastname: Borkon
authors.forename: W A
authors.initials: WA
authors.lastname: Reed
authors.forename: M E
authors.initials: ME
authors.lastname: Gorton
authors.forename: G M
authors.initials: GM
authors.lastname: Gura
authors.forename: A H
authors.initials: AH
authors.lastname: Kragel
mesh_terms: D000368:Aged; D016280:Atrial Function, Right; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery