Implantation of cardioverter-defibrillator: effects on shoulder function

Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood.

Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life.

Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5 ± 9.1 to 41.8 ± 11.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase ≥ 1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001).

ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.