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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Symptomatic pericardial disease associated with patch electrodes of the automatic implantable cardioverter
P Chevalier1, E Moncada, G Canu
1Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France.
Insights
Constrictive pericarditis may occur in patients with implantable cardioverter-defibrillators (ICDs) using patch electrodes. Removing these patches can resolve symptoms, suggesting a link between ICD patches and constrictive pericarditis.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Implantable cardioverter-defibrillators (ICDs) with epicardial patch electrodes are used for managing cardiac arrhythmias.
- Constrictive pericarditis is a condition affecting the pericardium, leading to impaired cardiac filling.
Observation:
- Three patients (out of 35) who received ICDs with patch electrodes developed clinical and hemodynamic signs of constrictive pericarditis.
- Symptoms included exertional dyspnea, high filling pressures, and diastolic pressure abnormalities.
Findings:
- Two patients presented with signs of heart failure (right or left) after ICD implantation.
- Removal of the ICD patch electrodes and replacement with endocardial leads led to significant clinical improvement in all affected patients.
Implications:
- Constrictive pericarditis associated with epicardial ICD patches is a potential complication of ICD therapy.
- Clinicians should consider this diagnosis in patients with cardiac decompensation following ICD implantation with patch electrodes.
Abstract:
Constrictive pericarditis can be associated with ICD patch electrodes. During a mean follow-up of 24 months, in a population of 35 patients who received ICDs with a patch electrodes configuration, we identified three patients with clinical and hemodynamic signs compatible with this event. Patient 1, a 35-year-old male, underwent implantation of an ICD because of a primary electrical disease complicated by cardiac arrest. Fourteen months later he complained of exertional dyspnea without any signs of heart failure. Right heart catheterization showed high filling pressures and diastolic dip and plateau in pressure curves. Thoracotomy and pericardial exploration were performed. Three months after removal of the patches and insertion of an endocardial lead system, the patient had normal respiration. Patients 2 and 3, who suffered from coronary heart disease without heart failure, exhibited a hemodynamic profile suggestive of constrictive pericarditis: in one patient, 10 months after ICD implantation, associated with right heart failure; and in the other, 18 months after ICD implantation with left heart failure. Patch electrodes were removed in these two patients and replaced by endocardial lead electrodes with subsequent clinical improvement. It is concluded that constrictive pericarditis related to epicardial patch is not an uncommon occurrence during ICD therapy and should be considered in patients who show clinical signs of cardiac decompensation.
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