POSTOPERATIVE LEAD-RELATED COMPLICATIONS IN PATIENTS WITH NONTHORACOTOMY DEFIBRILLATION LEAD SYSTEMS

Objectives. This study sought to document postoperative complications attributable to nonthoracotomy defibrillation lead systems in a large cohort. Background. The incidence of postoperative complications speci fically associated with nonthoracotomy defibrillation lead systems is unknown. Methods. Postoperative lead-related complications were evalua ted in 170 patients,vith a nonthoracotomy defibrillation lead system w ho were followed up for a mean (+/-SD) of 17 +/- 12 months. Each syste m incorporated one or more intravascular leads. In 117 patients (69%), the system incorporated a subcutaneous defibrillation patch. All impl antations were performed in an operating room by cardiothoracic surgeo ns. Defibrillation thresholds were measured at implantation, before ho spital discharge (mean 3 +/- 2 days) and at 4 to 18 weeks after implan tation, Patients were evaluated every 2 to 3 months after implantation or as indicated by clinical exigency. Results. Twenty-seven patients (15.9%) were diagnosed with a lead-related complication that either ex tended the initial hospital period or led to a second hospital admissi on. Complications included endocardial lead or subcutaneous defibrilla tion patch dislodgment in eight patients (4.7%), which was diagnosed b etween 2 and 345 days after implantation; endocardial or subcutaneous patch lead fracture in six (3.5%), which was diagnosed between 53 and 600 days after implantation; subcutaneous patch mesh fracture in one, which was diagnosed at 150 days after implantation; subclavian vein th rombosis in three (1.8%), which was diagnosed at 2 to 50 days after im plantation; and unacceptably elevated defibrillation threshold (within 5 J of maximal device output) in nine (5.3%), which was documented at one of the two postimplantation evaluations in eight patients or at t he time of failure to terminate a spontaneous ventricular tachycardia in one. Seventeen of the 27 patients required reoperation for correcti on of their complication. In addition, system infection requiring comp lete explantation occurred in seven other patients (4.1%) at an interv al from implantation ranging from 14 to 120 days. Conclusions. Postope rative complications related to a nonthoracotomy defibrillation lead s ystem were common and frequently required reoperation for correction, The rate of system explantation due to infection was also significant. Postoperative defibrillation testing and vigilant outpatient follow u p evaluation are necessary to ensure normal lead function.