title: Implantation of cardioverter-defibrillator: effects on shoulder function.
abstract: BACKGROUND
  Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood.
  
  
  METHODS
  Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life.
  
  
  RESULTS
  Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5 ± 9.1 to 41.8 ± 11.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase ≥ 1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001).
  
  
  CONCLUSIONS
  ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.
authors.affiliation: Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy. igor.diemberger@gmail.com
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Francesco
authors.initials: F
authors.lastname: Pegreffi
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazzotti
authors.forename: Elia
authors.initials: E
authors.lastname: Foschi
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Maietta Latessa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Porcellini
authors.forename: Claudio
authors.initials: C
authors.lastname: Tentoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012782:Shoulder / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome