BACKGROUND: Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. METHODS AND RESULTS:Between June 1, 1993, and April 7, 1997, 539 patients receivednonthoracotomy ICDs either as initial treatment assignment (477) or as crossover from medical management (62). A total of 62 first complications occurred. The subclavian route of insertion resulted in more complications than the cephalic vein route, 46 of 339 (14%) versus 6 of 135 (4%), P = .005, as did the abdominal versus pectoral generator site, 31 of 238 (13%) versus 17 of 291 (6%), P<.02. Most dislodgements and system infections tended to occur in the 3 months after implantation, whereas lead fractures continued to occur throughout follow-up. Failure to use perioperative antibiotics was a predictor of system infection (P = .001). CONCLUSIONS: These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.
RCT Entities:
BACKGROUND: Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. METHODS AND RESULTS: Between June 1, 1993, and April 7, 1997, 539 patients received nonthoracotomy ICDs either as initial treatment assignment (477) or as crossover from medical management (62). A total of 62 first complications occurred. The subclavian route of insertion resulted in more complications than the cephalic vein route, 46 of 339 (14%) versus 6 of 135 (4%), P = .005, as did the abdominal versus pectoral generator site, 31 of 238 (13%) versus 17 of 291 (6%), P<.02. Most dislodgements and system infections tended to occur in the 3 months after implantation, whereas lead fractures continued to occur throughout follow-up. Failure to use perioperative antibiotics was a predictor of system infection (P = .001). CONCLUSIONS: These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.
Authors: Massimo Santini; Riccardo Cappato; Dietrich Andresen; Johannes Brachmann; D Wyn Davies; John Cleland; Alessandro Filippi; Edoardo Gronda; Richard Hauer; Gerhard Steinbeck; David Steinhaus Journal: J Interv Card Electrophysiol Date: 2009-03-06 Impact factor: 1.900
Authors: Riccardo Cappato; Warren M Smith; Margaret A Hood; Ian G Crozier; Luc Jordaens; Stefan G Spitzer; Andrey V Ardashev; Lucas Boersma; Pierpaolo Lupo; Andrew A Grace; Gust H Bardy Journal: J Interv Card Electrophysiol Date: 2012-03-17 Impact factor: 1.900
Authors: Teresa L Rogstad; Adam C Powell; Yongjia Song; Tristan Cordier; Stephen E Price; James W Long; Uday U Deshmukh; Jeffrey D Simmons Journal: Clin Cardiol Date: 2018-09-20 Impact factor: 2.882