VALUE OF RADIOGRAPHY IN DIAGNOSING COMPLICATIONS OF CARDIOVERTER-DEFIBRILLATORS IMPLANTED WITHOUT THORACOTOMY IN 437 PATIENTS

OBJECTIVE. This study evaluated the usefulness of radiography in asses sing the frequency and cause of complications of nonthoracotomy-implan ted cardioverter defibrillators. MATERIALS AND METHODS. Between May 19 92 and December 1995, 437 consecutive patients at our institution unde rwent cardioverter defibrillator placement. Routine follow-up included external device testing at 6 weeks after placement and every 3 months thereafter. Chest radiographs were obtained immediately after placeme nt, annually, and at the time of any suspected complication. Retrospec tive review of radiographs and medical charts was done for all patient s with clinical complications. RESULTS. Forty-five complications (10%) were clinically diagnosed: lead or patch fracture in fifteen (33%) pa tients, electric lead dysfunction in eight (18%), infection in eight ( 18%), lead retraction in six (13%), patch fold in two (5%), hematoma i n two (5%), and other complications in four (9%) patients. Eighteen co mplications (40%) were radiographically evident. Lead retraction, hema toma, patch fold, patch migration, and the twiddler syndrome were radi ographically confirmed in 100% of cases. The average time for these co mplications to be detected was 68 days; 92% were detected within 23 da ys. Conversely, only four (27%) lead fractures, one (13%) electric lea d dysfunction, and one (13%) infection were radiographically confirmed . These latter complications were discovered an average of 579 days af ter cardioverter defibrillator placement. CONCLUSION. Radiography play s a secondary role in the diagnosis of cardioverter defibrillator comp lications and is particularly limited beyond 1 month after placement. Radiographs may be helpful in the first month after placement because early complications are the most radiographically apparent.