Frozen shoulder syndrome associated with subpectoral defibrillator implantation

Pectoral implantation of transvenous non-thoracotomy internal cardioverter defibrillators (ICD) has resulted in very few complications whether placed subpectorally or subcutaneously. We report the case of a 68 year old man wi th a subpectorally implanted MINI-plus (Cardiac Pacemakers, Incorporated, S t. Paul, Mn.) transvenous ICD who developed nearly instantaneous severe ips ilateral shoulder pain and immobilization. The symptoms progressed despite aggressive physical therapy. We elected to remove the device from the pectoral site and place it in a tr aditional abdominal position due to the severity, duration and refractorine ss of his symptoms. This procedure utilized the chronic Endotak DSP (Model 0125, Cardiac Pacemakers, Incorporated) transvenous lead, a compatible Endo tak DSP lead extender (Model 6952, Cardiac Pacemakers, Incorporated) and th e above described ICD. Immediate relief of symptoms was accomplished by rel ocation of the device to an abdominal site. This intervention should be reserved for patients with severely debilitatin g symptoms. Prospective comparison of subpectoral and subcutaneous surgical approaches with respect to patient comfort and acceptance and complication s may be warranted.