SYMPTOMATIC PERICARDIAL DISEASE-ASSOCIATED WITH PATCH ELECTRODES OF THE AUTOMATIC IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR - AN UNDERESTIMATED COMPLICATION

Constrictive pericarditis can be associated with ICD patch electrodes. During a mean follow-up of 24 months, in a population of 35 patients who received ICDs with a patch electrodes configuration, ne identified three patients with clinical and hemodynamic signs compatible with th is event. patient 1, a 35-year-old male, underwent implantation of an ICD because of a primary electrical disease complicated by cardiac arr est. Fourteen months later he complained of exertional dyspnea without any signs of heart failure. Right heart catheterization show ed high filling pressures and diastolic dip and plateau in pressure curves. Th oracotomy and pericardial exploration rr ere performed. Three months a fter removal of the patches and insertion of an endocardial lead syste m, the patient had normal respiration. patients 2 and 3, who suffered from coronary heart disease without heart failure, exhibited a hemodyn amic profile suggestive of constrictive pericarditis: in one patient, 10 months after ICD implantation, associated with right heart failure; and in the other 18 months after TCD implantation with left heart fai lure. Patch electrodes were removed in these two patients and replaced by endocardial lead electrodes with subsequent clinical improvement. I is concluded that constrictive pericarditis related to epicardial pa tch is not an uncommon occurrence during ICD therapy and should be con sidered in patients rr ho show clinical signs of cardiac decompensatio n.