Fate of explanted ICD patients

Permanent explantation of implantable cardioverter defibrillators

Although ICD therapy is seen as an irrevocable mode of therapy in most patients, a small number of patients do have their devices permanently explanted. The long-term outcome in these patients has not been described. The purpose of this single center study was to evaluate the long-term outcome of patients whose ICD was explanted and not replaced and to propose clinical variables that can be considered when making the decision to discontinue therapy. Ten of 323 (3.1%) patients in our ICD registry had their devices permanently explanted or turned off between 1986 and December 1998. The devices had been in place for 39 +/- 31 months preexplant. No patient had received appropriate therapy prior to surgery, which was indicated for infection or lead fracture. All patients are alive and well 75 +/- 30 months postexplant with 1 (10%) patient requiring late reimplantation. We reviewed the English language literature describing ICD explanation without replacement. A total of 151 patients were reported in eight studies and were followed for up to 30 months postexplant. Excluding patients with terminal illness or heart transplantation 57.6% survived without reimplantation. In selected patients, after not using an ICD for a long period and when clinical circumstances justify, device therapy may be discontinued with some degree of safety.

Clinical outcome following ICD removal. The Bilitch Registry Group

The Bilitch ICD Registry includes 1,869 patients from 13 medical centers enrolled between March 1982 and April 1992. Of these, 95 patients had their units removed and not immediately replaced (77 males/18 females mean age 54.9 +/- 13.0 years, range 10-76). The mean duration of implanted ICD was 19.5 +/- 18.2 months, mean ejection fraction 30.1 +/- 11.7%. Coronary artery disease was present in 55 patients, absent in 30, and unknown in 10. The presenting clinical event was sudden death in 35 patients, symptomatic ventricular tachycardia in 34, other causes in 6, and unknown in 20. Reasons for ICD removal were: infection in 33 patients, cardiac transplant in 32, elective in 20, following battery depletion in 7, lead system failure in 2, and inappropriate shock in 1. Of all groups who had their ICD removed, the patients who had removal for cardiac transplantation had the highest incidence of appropriate ICD discharges while the device was implanted (43.8%). Of the 63 nontransplanted patients seven were lost to follow-up while alive. Of the 56 remaining, 17 died (1 cause unknown, 6 noncardiac, 3 sudden, 1 arrhythmic, 6 nonsudden nonarrhythmic cardiac death), 7 had an ICD reimplanted, and 32 are alive and well without an ICD. Follow-up for the 32 cardiac transplant patients: 2 were lost to follow-up while alive, 2 died of nonsudden nonarrhythmic death, and 28 are alive and well. The survival of patients who had their ICD removed and not reimplanted was not different from that of patients who never had their ICD removed up to 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Complications of implantable cardioverter defibrillator therapy: follow-up of 241 patients

In order to determine the incidence of complications of implantable cardioverter defibrillator (ICD) therapy, 241 patients with a total of 353 ICD implantations were followed for 24 +/- 20 months. Complications were defined as any untoward effects experienced by the patient related to the ICD implantation and function or death within 4 weeks of implant or before hospital discharge. During follow-up, 129 of 241 patients (53%) had a total of 166 complications. An operative procedure was required to correct the complication in 50 of the 241 patients (21%). No patient died intraoperatively, but eight patients died within 4 weeks postoperatively or before hospital discharge. ICD infection required removal of the device in 13 patients (5%). Twenty-six patients (11%) had postoperative respiratory complications. Postoperative bleeding and/or thrombosis occurred in 11 patients (4%). Endocardial lead migration was observed in nine patients (4%) and lead adapter or insulation break occurred in nine patients (4%). Fifty-four patients (22%) experienced ECG-documented discharges for non-VT rhythm. In conclusion, although perioperative mortality in ICD patients is low, the majority of patients have complications during follow-up. Recognition of these complications may allow for advances in ICD technology and management strategies to avoid their occurrence.