Europace Advance Access published online on December 2, 2008
Europace, doi:10.1093/europace/eun322
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CLINICAL RESEARCH
Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices
Division of Cardiology, Section Clinical Electrophysiology, Department of Medicine, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
Aims: Implantable cardioverter defibrillator (ICD) technology has become more complex, particularly with respect to biventricular resynchronization devices. The incidence of hardware-related complications in single (SC)-, dual (DC)-, and triple (BiV)-chamber devices requiring surgical revision has not been investigated systematically.
Methods and results: We analysed data from consecutive ICD recipients implanted between January 2000 and December 2007 with respect to the need of surgical re-intervention for device- or lead-related complications. Generator exchanges due to normal battery depletion were not considered. From 816 patients (81% male, 69% ischaemic cardiomyopathy, 48% secondary prevention ICDs) followed for 31 ± 24 months (2118 cumulative patient-years), 98 patients underwent 110 revisions (5.2% per patient-year). Complications included lead-related revision procedures in 81 cases and generator-related problems in 29 cases. The annual incidence of surgical revision due to complications was 11.8% in BiV compared with 4.9% in SC and 4.1% in DC patients (P = 0.002). This higher revision rate was mainly caused by lead-related complications. Implantation of a BiV system was an independent risk factor of the need for surgical revision (relative risk 2.37, 95% confidence interval 1.38–4.04).
Conclusion: Even with long-lasting operator experience, complications requiring surgical revision remain a clinically important problem of ICD therapy. The incidence of complications is significantly higher in BiV resynchronization devices than in SC and DC systems.
Key Words: Implantable defibrillator, Complications, Surgical revision, Cardiac resynchronization therapy, Lead complication
* Corresponding author. Tel: +49 69 6301 7404, Fax: +49 6173 950290, Email: hohnloser{at}em.uni-frankfurt.de
Manuscript submitted 28 July 2008. Accepted after revision 22 October 2008.
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