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Jeffrey M. Piehler
Duncan A. Killen
A. Michael Borkon
William A. Reed
Michael E. Gorton
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Ann Thorac Surg 1995;59:684-688
© 1995 The Society of Thoracic Surgeons

Right Atrial Compression Related to Defibrillator Patches

Jeffrey M. Piehler, MD, Duncan A. Killen, MD, A. Michael Borkon, MD, William A. Reed, MD, Michael E. Gorton, MD, George M. Gura, Jr, MD, Amy H. Kragel, MD

Department of Cardiovascular Diseases, Sections of Cardiovascular Surgery and Cardiology, and Department of Pathology, Mid-America Heart Institute of Saint Luke's Hospital, Kansas City, Missouri

Accepted for publication November 19, 1994.

Acceptable function of an internal defibrillator can be achieved with different patch orientations. For patients requiring defibrillator patches concomitant with a cardiac procedure requiring extracorporeal circulation, application of one of the patches within the pericardium adjacent to the right atrium has provided excellent defibrillation thresholds. We describe 4 such patients in whom a compressing thrombus subsequently developed between the patch and the atrium. The thrombus was small and asymptomatic in 1 patient, but caused localized tamponade requiring reexploration in 2 patients and a fatal superior vena caval obstruction in 1. The precise etiology of this serious complication remains unclear, but its occurrence argues against the application of intrapericardial defibrillator patches in this orientation.






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