Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices

Europace. 2009 Mar;11(3):297-302. doi: 10.1093/europace/eun322. Epub 2008 Dec 2.

Abstract

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.

MeSH terms

  • Aged
  • Defibrillators, Implantable / statistics & numerical data*
  • Device Removal / statistics & numerical data*
  • Electrodes, Implanted / statistics & numerical data*
  • Equipment Failure / statistics & numerical data*
  • Female
  • Germany
  • Heart Failure / epidemiology*
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies