Implantable cardioverter defibrillators: risks accompany the life-saving benefits

Abstract

Sudden cardiac arrest is the one of the most common causes of death in developed countries and accounts for between 180,000 and over 450,000 per year in the USA. Antiarrhythmic drug approaches to prevention of sudden cardiac death have been resoundingly ineffective. The implantable cardioverter defibrillator (ICD) constitutes one of the most important and well validated therapeutic advances in modern cardiovascular medicine. Consequently, ICD use has increased exponentially, although implementation has been quite variable geographically and with respect to other measures. In view of the expanded use of ICDs, the potential shortcomings and risks of ICD therapy have attracted attention. This commentary summarises the weaknesses, disadvantages and risks of the ICD in a balanced fashion in light of their proven life-saving benefits.

Graft-versus-host disease: A rare complication of device implantation

“…The incidence of complications with device implantation has been reported to be approximately 3%-6% 2 . The most common complications of device implantation are pneumothorax, infection, and device-pocket hematoma requiring evacuation 3 .…”

Use and Abuse of Internal Cardioverter Defibrillators for Primary Prevention

“…post-shock pulseless electrical activity (PEA), refractory VF, or embolism from conversion of AF), and rarely death. 37 Acute complications occurred in approximately 5 % of patients in the SCD-HeFT trial and 2.5 % of the MADIT II patients. 15,23 Infection ICD infection is an uncommon but serious complication that is associated with a high mortality rate.…”

Combined vascular and neurologic injury after cephalic vein cutdown approach for ICD implantation

“…[8] A meta-analysis of patients undergoing device implantation who had not received any anticoagulation reported the incidence of bleeding as 2.2 out of 100 cases. [9] In our two cases, we report examples of rare complications of device implantation due to direct injury to subclavian vein and artery during cephalic vein cut down in the first and during subpectoralis pocket formation in the second case.…”