COMPLICATIONS WITH THE IMPLANTABLE CARDIO VERTER-DEFIBRILLATOR USING THE TRANSVENOUS-SUBCUTANEOUS APPROACH

Due to technical improvement using the transvenous-subcutaneous approa ch for lead fixation for cardioverter-defibrillator implantation, the incidence of device implantation has extended enormously. While a sign ificant lower perioperative mortality in transvenously implanted syste ms compared to epicardially fixed implantable cardioverter-defibrillat or (ICD) has been proven, perioperative as well as complications durin g follow-up are not analyzed systematically. In 59 patients, in whom t ransvenous-subcutaneous ICDs had been implanted, 3 patients showed ble eding complications in the subcutaneous patch area, 1 patient showed a bleeding in the device pocket, and in 1 patient a seroma in the subcu taneous patch region was observed necessitating surgical revisions. Du ring follow-up of 10 +/- 7 months, lead dislocations were observed in 6 patients, in another 6 patients patch crinkling was observed. There was 1 patient with a lead fracture as well as 1 patient with a bleedin g in the subcutaneous patch region. Despite the high efficacy of this therapy used in patients with life-threatening ventricular arrhythmias , these potential complications have to be considered.