Medium-term complications of automatic implantable cardiac defibrillators

The incidence and the nature of medium-term complications of automatic impl antable cardiac defibrillators (AICD) were studied. Seventy-nine AICD were implanted in 50 consecutive patients (42 men, aged 5 4.5 +/- 13.7 years). forty-six patients had spontaneous ventricular arrhyth mia. These arrhythmias were resistant to treatment (N=9), reproducible with treatment (N=28). In 4 patients, the indication was prophylactic, in 2 a B rugada syndrome, in 2 syncope with reinducible ventricular tachycardia and in 1 patient, torsades with a short coupling interval. forty-six patients h ad underlying cardiac disease (ischaemic, N=28, primary dilated cardiomyopa thy, N=10 others, N=8). The ejection fraction was >40% in 32 patients. The average follow-up was 41.3 +/- 34.9 months. Eight patients died, 2 from cardiac failure. Twenty-one patients (42%) had 1 or more complications rel ated to their AICD. These occurred: in the operative period (N=3) : 1 post- shock atrioventricular block, 1 ruptured electrode and 1 increased threshol d wit amiodarone : in the postoperative period (N=6) : infection in 3 cases , cerebrovascular accident in 1 case, deep venous thrombosis of the left ar m in 1 case, pneumothorax in 1 case. In the medium-term, the complication w ere mainly inappropriate electrical shocks observed in 14 patients related to atrial arrhythmias in 7 cases, sinus tachycardia in 1 case, over-detecti on of myopotentials in 2 cases and electrode dysfunction in 4 cases. In add ition, the authors observed complications related to the material : AICD fa ilure in 1 case, electrode displacement in 1 case, and electrode rupture in 3 cases. The authors conclude that AICD are effective for the treatment of malignant ventricular arrhythmias which justify strict specialist follow-up given th e incidence and diversity of their complications.