Incidence of defibrillator patch infection due to pulmonary erosion

Intrathoracic defibrillator patches were used prior to effective transvenous defibrillation systems. Spontaneous erosion through the visceral pleural has been documented but the incidence has not been previously reported.

All patients who underwent insertion of ICD patches at Westmead Hospital were identified from Hospital and device company databases. Medical records were reviewed and further follow-up performed through local doctors and the National Registry of Deaths where appropriate.

One hundred and four patients underwent insertion of ICD intrathoracic patches between 1987 and 2000. The patches were positioned adjacent to the pericardium in the pleural cavity. Eight patients died within three months of surgery and two patients developed early ICD infection. Of the other 94 patients, 40 were alive at the time of last review such that there had been 562 patient years of survival with four patients developing spontaneous patch infection. The incidence was 0.7% per patient year. The diagnosis was delayed in all four patients. All underwent removal of the ICD system with one perioperative death.

There is a small but significant risk of late spontaneous ICD patch infection. The condition is life-threatening and the diagnosis is usually delayed.