Strategic choices to reduce implantable cardioverter-defibrillator-related morbidity

Abstract

The number of patients undergoing implantation of a cardioverter-defibrillator (ICD) is increasing, as the indications for device therapy have broadened. Despite the mortality benefits associated with ICDs, they can also cause substantial complications. Drs. Wazni and Wilkoff explore the issues involved in managing patients with an ICD and discuss approaches for reducing these adverse effects, from prevention of infection, and the choice of lead and implantation technique, to strategies for programming and monitoring the device. The indications for ICD implantation continue to expand; however, these devices are associated with complications related to the implantation procedure itself and morbidity caused by the normal and abnormal functioning of the components comprising the system. Several factors need to be considered when embarking on initiating ICD implantation. Special consideration should be given to implantation technique and choice of operator to decrease acute complications. After implantation, the device should be appropriately programmed to minimize unnecessary pacing and decrease the likelihood of inappropriate shocks. Therapy should, in most cases, be painless and can be achieved by adhering to simple programming recommendations. A well-established and efficient follow-up program, ideally incorporating remote monitoring, is very important to ensure compliance and to monitor therapy and the integrity of the various device components—particularly given the possibility of device or lead malfunction.