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Open Access Research article

Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

Andreas Keyser1*, Michael K Hilker1, Ekrem Ücer2, Sigrid Wittmann3, Christof Schmid1 and Claudius Diez1

Author Affiliations

1 Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany

2 Department of Cardiology, University Medical Center, Regensburg, Germany

3 Department of Anesthesiology, Regensburg, Germany

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Journal of Cardiothoracic Surgery 2013, 8:77  doi:10.1186/1749-8090-8-77

Published: 11 April 2013

Abstract

Background

Implantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered.

Methods

In a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%.

Results

Five patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures.

Conclusion

Implantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs.

Keywords:
Implantable cardioverter defibrillator; Right-sided implantation; Intraoperative test