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Strategic choices to reduce implantable cardioverter-defibrillator-related morbidity

Nature Reviews Cardiology volume 7, pages 376–383 (2010)Cite this article

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Abstract

The indications for ICD implantation continue to expand; however, these devices are associated with complications related to the implantation procedure itself and morbidity caused by the normal and abnormal functioning of the components comprising the system. Several factors need to be considered when embarking on initiating ICD implantation. Special consideration should be given to implantation technique and choice of operator to decrease acute complications. After implantation, the device should be appropriately programmed to minimize unnecessary pacing and decrease the likelihood of inappropriate shocks. Therapy should, in most cases, be painless and can be achieved by adhering to simple programming recommendations. A well-established and efficient follow-up program, ideally incorporating remote monitoring, is very important to ensure compliance and to monitor therapy and the integrity of the various device components—particularly given the possibility of device or lead malfunction.

Key Points

  • ICD implantation should, ideally, be performed by physicians with training in clinical cardiac electrophysiology; procedures conducted by electrophysiologists are associated with the lowest rates of complication

  • Universal infection prevention techniques and prophylactic antibiotic therapy help to reduce the risk of device-related infection

  • The choice of ICD lead and implantation technique should be individualized to the patient to minimize the risk of lead failure

  • The ICD should be programmed to optimize the use of antitachycardia pacing and minimize right ventricular pacing and inappropriate therapy

  • Remote monitoring of the ICD reduces the number of follow-up clinic visits required and improves patient satisfaction

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Figure 1: Chest X-ray showing clavicular–first rib (subclavian) crush.

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  1. Department of Cardiovascular Medicine, Cleveland Clinic, Main Campus, 9500 Euclid Avenue, Cleveland, 44195, OH, USA

    Oussama Wazni & Bruce L. Wilkoff

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  1. Oussama Wazni
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Correspondence to Bruce L. Wilkoff.

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B. L. Wilkoff has acted as a consultant for InnerPulse, LifeWatch, Medtronic, and Spectranetics and has received research support from Biotronik, Boston Scientific, Medtronic, Spectranetics, and St Jude Medical. O. Wazni declares no competing interests.

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Wazni, O., Wilkoff, B. Strategic choices to reduce implantable cardioverter-defibrillator-related morbidity. Nat Rev Cardiol 7, 376–383 (2010). https://doi.org/10.1038/nrcardio.2010.50

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