title: Value of radiography in diagnosing complications of cardioverter defibrillators implanted without thoracotomy in 437 patients.
abstract: OBJECTIVE
  This study evaluated the usefulness of radiography in assessing the frequency and cause of complications of nonthoracotomy-implanted cardioverter defibrillators.
  
  
  METHODS
  Between May 1992 and December 1995, 437 consecutive patients at our institution underwent cardioverter defibrillator placement. Routine follow-up included external device testing at 6 weeks after placement and every 3 months thereafter. Chest radiographs were obtained immediately after placement, annually, and at the time of any suspected complication. Retrospective review of radiographs and medical charts was done for all patients with clinical complications.
  
  
  RESULTS
  Forty-five complications (10%) were clinically diagnosed: lead or patch fracture in fifteen (33%) patients, electric lead dysfunction in eight (18%), infection in eight (18%), lead retraction in six (13%), patch fold in two (5%), hematoma in two (5%), and other complications in four (9%) patients. Eighteen complications (40%) were radiographically evident. Lead retraction, hematoma, patch fold, patch migration, and the twiddler syndrome were radiographically confirmed in 100% of cases. The average time for these complications to be detected was 68 days; 92% were detected within 23 days. Conversely, only four (27%) lead fractures, one (13%) electric lead dysfunction, and one (13%) infection were radiographically confirmed. These latter complications were discovered an average of 579 days after cardioverter defibrillator placement.
  
  
  CONCLUSIONS
  Radiography plays a secondary role in the diagnosis of cardioverter defibrillator complications and is particularly limited beyond 1 month after placement. Radiographs may be helpful in the first month after placement because early complications are the most radiographically apparent.
authors.affiliation: Department of Medical Imaging, University of Pennsylvania-Presbyterian Medical Center, Philadelphia 19104, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: H G
authors.initials: HG
authors.lastname: Zegel
authors.forename: V S
authors.initials: VS
authors.lastname: Dravid
authors.forename: S J
authors.initials: SJ
authors.lastname: Nierenberg
authors.forename: D B
authors.initials: DB
authors.lastname: Freiman
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging; D013908:Thoracotomy; D013997:Time Factors