title: Complications of third-generation implantable cardioverter defibrillator therapy.
abstract: To determine the incidence of complications of third-generation implantable cardioverter defibrillator (ICD) therapy, 144 patients were prospectively studied who underwent first implant of third-generation devices (i.e., ICD systems with biphasic shocks, ECG storage capability, and nonthoracotomy lead systems). During 21 +/- 15 months of follow-up, 41 (28%) patients had one or more complications. No patient died perioperatively (30 days) and no ICD infection was observed during follow-up. Complications included bleeding or pocket hematoma (hemoglobin drop > 2 g/dL) in 5 (3%) patients, prolonged reversible ischemic neurological deficit in 1 (1%) patient, postoperative deep venous thrombosis of leg in 1 (1%) patient, pneumothorax in 2 (1%) patients, difficulty to defibrillate ventricular fibrillation intraoperatively in 2 (1%) patients, generator malfunction in 1 (1%) patient, arthritis of the shoulder in 3 (2%) patients, and allergic reaction to prophylactic antibiotics in 2 (1%) patients. A total of seven lead related complications were observed in six (4%) patients including endocardial lead migration in four (3%) patients. Twenty-three (16%) patients received inappropriate shocks for supraventricular tachyarrhythmias (n = 13), non-sustained ventricular tachycardia (VT) (n = 7), or myopotential oversensing (n = 3). We conclude that serious complications such as perioperative death or ICD infection are rare in patients with third-generation ICDs. Lead-related problems and inappropriate shocks during follow-up are the most frequent complications of third-generation ICD therapy. Recognition of these complications should promote advances in ICD technology and management strategies to avoid their recurrence.
authors.affiliation: Department of Cardiology, Hospital of the Philipps-University of Marburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Grimm
authors.forename: V
authors.initials: V
authors.lastname: Menz
authors.forename: J
authors.initials: J
authors.lastname: Hoffmann
authors.forename: U
authors.initials: U
authors.lastname: Timmann
authors.forename: R
authors.initials: R
authors.lastname: Funck
authors.forename: R
authors.initials: R
authors.lastname: Moosdorf
authors.forename: B
authors.initials: B
authors.lastname: Maisch
mesh_terms: D017147:Defibrillators, Implantable; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000295:instrumentation*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects*; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome