Complications of implantable cardioverter defibrillator: Diagnosis and management

Abstract

Implantable Automatic Defibrillator (ICD) has become the treatment of choice in the prevention of sudden rhythmic cardiac death. Its superiority over medical treatment has been demonstrated. However, this efficiency is offset by the occurrence of serious complications. In Tunisia and in the absence of a national register on implantable electronic cardiac devices, data on ICD are not listed. The aim of our study was to investigate the short and long-term complications of ICDs, and to discuss the means and solutions proposed in order to prevent them and reduce their incidence. This was a retrospective study over 15 years enrolling 183 patients with ICDs implanted and followed in the cardiology department of the Military hospital of Tunis. Data were retrieved from medical records and ICD memories. Analyses were conducted using SPSS version 21.0. The mean age of our predominately male patients was 56 ± 15 years. The major cardiac diseases were ischemic (43%), dilated non-ischemic cardiomyopathies (34%) and genetic (23%). CDs were implanted in secondary prevention in 51% of patients. They were double rooms (50%), triple rooms (30%) and single rooms (20%). The perioperative mortality rate is 0.9%. During an average follow-up of 54 months, 21% of patients received appropriate treatment while 11% received inappropriate shocks. The other short- and long-term complications were observed in 9.4% of patients; lead dysfunction (3.8%), lead dislodgements (2.2%), infectious endocarditis (1.1%) and venous thrombosis (1.1%). All these complications resulted in a re-hospitalization rate of 29%. ICD-related complications cause severe morbidity and mortality and indirectly reduce the blunted benefit of preventing sudden rhythmic death. Increased effort and vigilance in patient selection, implantation, programming and follow-up should be maintained to reduce these complications.