PERICARDIAL CONSTRICTION DUE TO EPICARDIA L PATCH ELECTRODES OF IMPLANTABLE AUTOMATIC DEFIBRILLATORS - 3 CASE-REPORTS

The authors report three cases of pericardial constriction secondary t o implantation of an automatic defibrillator. In one case, the pericar dial constriction occured 1 year after implantation and was associated with ascending infection of the patch electrodes from the stimulator; the patient died when the patch electrodes were removed, the infectio n having eroded the left ventricular wall. In the other two cases, sig ns of constriction appeared 2 years after implantation. In one of thes e patients, surgery showed a fibrous pericardial reaction deforming th e patch electrodes with a favourable outcome when the electrodes were removed. The other patient refused surgery. In the three cases, the di agnosis was confirmed by right heart catheterisation and ventriculogra phy which showed signs of adiastole and severe deformation of the vent ricular contours. Pericardial constriction due to patch electrodes is a potentially serious complication of implantable automatic defibrilla tors, the prevalence of which may be underestimated. The use of endoca vitary or extra-pericardial electrodes should avoid this complication.