TY - JOUR
T1 - Lead- and device-related complications in the antiarrhythmics versus implantable defibrillators trial
AU - Kron, Jack
AU - Herre, John
AU - Renfroe, Ellen Graham
AU - Rizo-Patron, Carlos
AU - Raitt, Merritt
AU - Halperin, Blair
AU - Gold, Michael
AU - Goldner, Bruce
AU - Wathen, Mark
AU - Wilkoff, Bruce
AU - Olarte, Anna
AU - Yao, Qing
N1 - Funding Information:
Supported by contract No. N01 HC-25117 from the National Heart, Lung, and Blood Institute, Bethesda, Md.
PY - 2001
Y1 - 2001
N2 - Background: Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. Methods and Results: Between June 1, 1993, and April 7, 1997, 539 patients received nonthoracotomy ICDs either as initial treatment assignment (477) or as crossover from medical management (62). A total of 62 first complications occurred. The subclavian route of insertion resulted in more complications than the cephalic vein route, 46 of 339 (14%) versus 6 of 135 (4%), P = .005, as did the abdominal versus pectoral generator site, 31 of 238 (13%) versus 17 of 291 (6%), P < .02. Most dislodgements and system infections tended to occur in the 3 months after implantation, whereas lead fractures continued to occur throughout follow-up. Failure to use perioperative antibiotics was a predictor of system infection (P = .001). Conclusions: These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.
AB - Background: Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. Methods and Results: Between June 1, 1993, and April 7, 1997, 539 patients received nonthoracotomy ICDs either as initial treatment assignment (477) or as crossover from medical management (62). A total of 62 first complications occurred. The subclavian route of insertion resulted in more complications than the cephalic vein route, 46 of 339 (14%) versus 6 of 135 (4%), P = .005, as did the abdominal versus pectoral generator site, 31 of 238 (13%) versus 17 of 291 (6%), P < .02. Most dislodgements and system infections tended to occur in the 3 months after implantation, whereas lead fractures continued to occur throughout follow-up. Failure to use perioperative antibiotics was a predictor of system infection (P = .001). Conclusions: These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.
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U2 - 10.1067/mhj.2001.111261
DO - 10.1067/mhj.2001.111261
M3 - Article
C2 - 11136492
AN - SCOPUS:0035169738
SN - 0002-8703
VL - 141
SP - 92
EP - 98
JO - American heart journal
JF - American heart journal
IS - 1
ER -