[The complications of implantable cardioverter-defibrillators and their treatment]

Infection of implantable cardioverter defibrillator (ICD) is a devastating event. In an effort to more fully understand ICD infection, the authors reviewed patients records recommending a strategy for management based on their satisfactory experience. From March 1993 through May 1998, 85 ICD were implanted in 64 male and 21 female patients. Transmediastinal approach was performed in 8 (9.5%) cases and transvenous in 77 (91.5%). All device-related infections were examined. Seven (8.25%) device-related infections occurred with a mean time interval of 3 months. In all cases bacterial infection was demonstrated. All infections involved the generator with or without other components involvement. First approach was conservative in all cases but it wasn't successful. Then the authors always used a surgical therapy, in 3 cases removing electrodes by traction and in 4 resorting to cardiopulmonary bypass (CPB). Two deaths were registered. Explantation of ICD resolved in all cases infective complications with no early or additional reinfections. In the last cases with devices implanted by transvenous approach and subpectoral generator implant, no infective complications were observed. In authors experience a complete removal of the ICD generator as well as of all its components is to be preferred as soon as the infections develops.