Pocket infection as a complication of a subcutaneous implantable cardioverter-defibrillator

Abstract

The use of implantable cardiac devices has increased in the last 30 years. The evolution of devices in serious cardiac rhythm pathology management has led progressively to the development of devices for the treatment of bradycardia, ventricular arrhythmia and heart failure and for the prevention of sudden cardiac arrest leading to delivery of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) plus ICD (CRT-D) [1–22] and to the recent subcutaneous implantable cardioverter-defibrillator (S-ICD) [23–25]. Infectious complications leading also to endocarditis [1,8, 26–33] and noninfectious complications [9,21,23,34–37] often necessitating removal [1,2,8,37–43] affect patients well-being also leading to psychological difficulties increase [44–50]. In the emerging scenario of concomitant problems and diseases [51–67], the S-ICD can provide clinical advantages in patients undergoing possible complications and in those with limited intracavitary lead placements, chronic indwelling catheters, obstructed venous access and in young patients avoiding the need for electrodes within the heart [23–25]. Complications are always possible, such as pocket and system infections, lead dislodgement, suboptimal position, lead dislodgement, oversensing, inappropriate shock and premature battery depletion but the new alternative technique of s-ICD represents an important innovation in the field of device therapy