Gupta A, Zegel H G, Dravid V S, Nierenberg S J, Freiman D B
Department of Medical Imaging, University of Pennsylvania-Presbyterian Medical Center, Philadelphia 19104, USA.
AJR Am J Roentgenol. 1997 Jan;168(1):105-8. doi: 10.2214/ajr.168.1.8976930.
This study evaluated the usefulness of radiography in assessing the frequency and cause of complications of nonthoracotomy-implanted cardioverter defibrillators.
Between May 1992 and December 1995, 437 consecutive patients at our institution underwent cardioverter defibrillator placement. Routine follow-up included external device testing at 6 weeks after placement and every 3 months thereafter. Chest radiographs were obtained immediately after placement, annually, and at the time of any suspected complication. Retrospective review of radiographs and medical charts was done for all patients with clinical complications.
Forty-five complications (10%) were clinically diagnosed: lead or patch fracture in fifteen (33%) patients, electric lead dysfunction in eight (18%), infection in eight (18%), lead retraction in six (13%), patch fold in two (5%), hematoma in two (5%), and other complications in four (9%) patients. Eighteen complications (40%) were radiographically evident. Lead retraction, hematoma, patch fold, patch migration, and the twiddler syndrome were radiographically confirmed in 100% of cases. The average time for these complications to be detected was 68 days; 92% were detected within 23 days. Conversely, only four (27%) lead fractures, one (13%) electric lead dysfunction, and one (13%) infection were radiographically confirmed. These latter complications were discovered an average of 579 days after cardioverter defibrillator placement.
Radiography plays a secondary role in the diagnosis of cardioverter defibrillator complications and is particularly limited beyond 1 month after placement. Radiographs may be helpful in the first month after placement because early complications are the most radiographically apparent.
本研究评估了X线摄影在评估非开胸植入式心脏复律除颤器并发症的发生率及原因方面的实用性。
1992年5月至1995年12月期间，我院连续437例患者接受了心脏复律除颤器植入术。常规随访包括植入后6周及此后每3个月进行一次体外设备测试。植入后立即、每年以及在任何疑似并发症发生时均进行胸部X线摄影。对所有有临床并发症的患者的X线片和病历进行回顾性分析。
临床诊断出45例并发症（10%）：15例（33%）患者出现导线或电极片断裂，8例（18%）出现电导线功能障碍，8例（18%）出现感染，6例（13%）出现导线回缩，2例（5%）出现电极片折叠，2例（5%）出现血肿，4例（9%）患者出现其他并发症。18例并发症（40%）在X线片上表现明显。导线回缩、血肿、电极片折叠、电极片移位和旋转综合征在100%的病例中通过X线片得到证实。这些并发症被检测到的平均时间为68天；92%在23天内被检测到。相反，只有4例（27%）导线断裂、1例（13%）电导线功能障碍和1例（13%）感染通过X线片得到证实。这些后期并发症在心脏复律除颤器植入后平均579天被发现。
X线摄影在心脏复律除颤器并发症的诊断中起次要作用，且在植入后1个月以上时尤其有限。X线片在植入后的第一个月可能有帮助，因为早期并发症在X线片上最明显。
