Lead-related complications in 340 patients with an implantable cardioverter/defibrillator

From February 1991 to May 1998, 340 patients had a cardioverter/defibrillat or (ICD) implanted. Mean age was 64 +/- 9 years, 278 male and 62 female. 60 % of patients had coronary artery disease and 31% dilative cardiomyopathy. Ejection fraction was 38 +/- 14%. The indication for an implantable cardiov erter/defibrillator was in 57% of patients ventricular tachycardia, in 43% ventricular fibrillation. 298 patients had a single-chamber cardioverter/de fibrillator implanted, 42 patients a dual-chamber cardioverter/defibrillato r. In 25 patients additional subcutaneous patch or array electrodes and in 2 patients additional epicardial patch electrodes were implanted, Implantat ion site was in 92 patients abdominal and in 248 pectoral. Over a period of 7 years 34 lead-related complications occurred in 33 patients (9.7%), afte r a median of 2 months after implantation, Diagnosis was made by routine ch est x-ray in about 55% of lead-related complications, by clinical presentat ion (inadequate therapy, pain) in 24%, and by electrical parameters in 21%. In patients with an abdominal implantation site, lead-related complication s occurred in 20%, in contrast to 6% in patients with a pectoral implantati on site. Regarding patients with pectoral implantation site, lead-related c omplications were observed in 12% of patients with a dual-chamber ICD vs 4% with a single-chamber ICD (p = 0.05), due to dislocation of atrial electro des with dual-chamber ICD. There were no differences in clinical parameters between patients with pectoral vs abdominal and between single vs dual-cha mber ICD. There were no deaths due to lead-related complications.