Subcutaneous air entrapment after subcutaneous implantable cardioverter defibrillator implantation evaluated by computed tomography.

Abstract

Inappropriate shock (IAS) caused by subcutaneous air entrapment (AE) in an early period after subcutaneous implantable cardioverter defibrillator (S-ICD) implantation has been reported, however, no detailed data on air volume are available. We evaluated the subcutaneous air volume after implantation and its absorption rate one week after implantation. Patients who underwent S-ICD implantation in our hospital received chest CT scans immediately after implantation and followed up 1 week later. The total subcutaneous air volume, air around the generator, the distal electrode, and the proximal electrode within 3cm were calculated using a three-dimensional workstation. Fat areas at the level of the lower edge of the generator were also analyzed. Fifteen patients received CT immediately after implantation. The mean age was 45.6±17.9 (66.7% of men), and the mean body mass index was 24.3±3.3. The three-incision technique was applied in seven patients and two-incision technique was in the latter eight patients. The mean total subcutaneous air volume was 18.54±7.50mL. Air volume around the generator, the distal electrode, and the proximal electrode were 11.05±5.12, 0.72±0.72, and 0.88±0.87mL, respectively. Twelve patients received a follow-up CT 1 week later. The mean total subcutaneous air was 0.25±0.45mL, showing a 98.7% absorption rate. Although subcutaneous air was observed in all patients after S-ICD implantation, most of the air was absorbed within 1 week, suggesting a low occurrence of AE-related IAS after a week postoperation.