THE VANISHING DEFIBRILLATOR SYNDROME - INCIDENCE, MECHANISM, AND CLINICAL RELEVANCE

Intraperitoneal migration of an abdominally implanted cardioverter def ibrillator is a complication not yet fully described. In a consecutive series of 195 patients, migration occurred between 1 and 20 months in 5 (8%) of the 63 patients in whom a subrectus abdomini placement of t he generator was chosen. It was unrelated to the patients' clinical ch aracteristics or the defibrillator model. Dysuria and inability to int errogate the device were present in every subject, and the diagnosis w as confirmed by the characteristic abdominal x-ray appearance and the findings at the time of surgery. Adhesions involving the omentum, an d in one case, the small bowels, were present in three patients and seem to be related to the length of intraabdominal permanence of the gener ator. Because this complication may be due to specific anatomical char acteristics of the aponeurosis of the abdominal muscles, it is likely that its incidence will be unchanged by the use of smaller devices. A close follow-up of the generators implanted deep to the rectus fascio is therefore advisable.