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Borleffs, C.J.W.; Thijssen, J.; Bie, M.K. de; Rees, J.B. van; Welsenes, G.H. van; Erven, L. van; ... ; Schalij, M.J. (2010)

Recurrent Implantable Cardioverter-Defibrillator Replacement Is Associated with an Increasing Risk of Pocket-Related Complications

Article / Letter to editor
Methods: From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket-related complications requiring surgical re-intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket-related complications. Results: A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re-interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three-year cumulative incidence for first surgical re-intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9-5.5%). Replacement ICDs exhibited a doubled requirement for surgical re-intervention (rate ratio 2.2, 95% CI 1.5-3.0). Compared to first implanted ICDs, the occurrence of surgical re-intervention in replacements was 2.5 (95% CI 1.6-3.7) times higher for infectious and 1.7 (95% CI 0.9-3.0) for noninfectious causes. Subdivision by the number of ICD...Show moreMethods: From 1992 to 2008, 2,415 patients receiving an ICD at the Leiden University Medical Center were analyzed. Pocket-related complications requiring surgical re-intervention following ICD implantation or replacement were noted. Elective device replacement, lead failure, and device malfunction were not considered pocket-related complications. Results: A total of 3,161 ICDs were included in the analysis. In total, 145 surgical re-interventions were required in 122 (3.9%) ICDs implanted in 114 (4.7%) unique patients. Three-year cumulative incidence for first surgical re-intervention in all ICDs was 4.7% (95% confidence interval [CI] 3.9-5.5%). Replacement ICDs exhibited a doubled requirement for surgical re-intervention (rate ratio 2.2, 95% CI 1.5-3.0). Compared to first implanted ICDs, the occurrence of surgical re-intervention in replacements was 2.5 (95% CI 1.6-3.7) times higher for infectious and 1.7 (95% CI 0.9-3.0) for noninfectious causes. Subdivision by the number of ICD replacements showed an increase in the annual risk for surgical re-intervention, ranging from 1.5% (95% CI 1.2-1.9%) for the first, to 8.1% (95% CI 1.7-18.3%) for the fourth implanted ICD. Conclusions: ICD replacement is associated with a doubled risk for pocket-related surgical re-interventions. Furthermore, the need for re-intervention increases with every consecutive replacement. (PACE 2010; 1013-1019).Show less
implantable cardioverter-defibrillator infection complications replacement sudden death antiarrhythmic-drug therapy cardiac device infections ventricular-arrhythmias heart-failure arrest amiodarone advisories prevention longevity pacemaker
All authors
Borleffs, C.J.W.; Thijssen, J.; Bie, M.K. de; Rees, J.B. van; Welsenes, G.H. van; Erven, L. van; Bax, J.J.; Cannegieter, S.C.; Schalij, M.J.
Date
2010-08-31
Journal
Pacing and Clinical Electrophysiology
Volume
33
Issue
8
Pages
1013 - 1019