Complications of Third‐Generation Implantable Cardioverter Defibrillator Therapy

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Abstract
To determine the incidence of complications of third‐generation implantable cardioverter defibrillator (ICD) therapy, 144 patients were prospectively studied who underwent first implant of third‐generation devices (i.e., ICD systems with biphasic shocks, ECC storage capability, and nonthoracotomy lead systems). During 21 ± 15 months of follow‐up, 41 (28%) patients had one or more complications. No patient died perioperatively (30 days) and no ICD infection was observed during follow‐up. Complications included bleeding or pocket hematoma (hemoglobin drop > 2 g/dL) in 5 (3%) patients, prolonged reversible ischemic neurological deficit in 1 (1%) patient, postoperative deep venous thrombosis of leg in 1 (1%) patient, pneumothorax in 2 (1%) patients, difficulty to defibrillate ventricular fibrillation intraoperatively in 2 (1%) patients, generator malfunction in 1 (1%) patient, arthritis of the shoulder in 3 (2%) patients, and allergic reaction to prophylactic antibiotics in 2 (1%) patients. A total of seven lead related complications were observed in six (4%) patients including endocardial lead migration in four (3%) patients. Twenty‐three (16%) patients received inappropriate shocks for supraventricular tachyarrhythmias (n = 13), non‐sustained ventricular tachycardia (VT) (n = 7), or myopotential oversensing (n = 3). We conclude that serious complications such as perioperative death or ICD infection are rare in patients with third‐generation ICDs. Lead‐related problems and inappropriate shocks during follow‐up are the most frequent complications of third‐generation ICD therapy. Recognition of these complications should promote advances in ICD technology and management strategies to avoid their recurrence.

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