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. 2013 Sep 20;168(1):294-9.
doi: 10.1016/j.ijcard.2012.09.071. Epub 2012 Oct 7.

Implantation of cardioverter-defibrillator: effects on shoulder function

Igor Diemberger  1 , Francesco Pegreffi, Andrea Mazzotti, Elia Foschi, Cristian Martignani, Guido Belli, Mauro Biffi, Matteo Ziacchi, Angelo Branzi, Francesco Grigioni, Pasqualino Maietta Latessa, Giuseppe Porcellini, Claudio Tentoni, Giuseppe Boriani
Affiliations

Implantation of cardioverter-defibrillator: effects on shoulder function

Igor Diemberger et al. Int J Cardiol. .

Abstract

Background: Subcutaneous almost substituted subpectoral approach of implantable cardioverter-defibrillator (ICD) implantation as a less invasive surgical technique. However, the impact of this change in placement site on procedure-related shoulder impairment is poorly understood.

Methods: Candidates for ICD implantation were prospectively evaluated at baseline, 2-weeks and 3-months after the procedure. Assessment of shoulder function included: Constant Score, Numeric Rating Scale (NRS) for pain and the Disability of the Arm, Shoulder and Hand (DASH) scoring method. The Short Form-36 (SF-36) questionnaire was adopted for quality of life.

Results: Fifty consecutive patients were enrolled (21 single-chamber, 5 dual-chamber and 24 biventricular ICD). Significant changes in the short term were observed: physical component summary (regarding SF-36) decreased from 44.5 ± 9.1 to 41.8 ± 11.4 (p=0.016), patients with NRS >1 increased from 14% to 44% (p<0.001), DASH score increased from 1.29 [interquartile range 0.00-10.34] to 30.60 [interquartile range 12.93-46.34] (p<0.001). Notably, only the shoulder ipsilateral to implantation site presented a decrease in Constant Score (76.00 [interquartile range 61.37-86.87] vs. 95.75 [interquartile range 91.37-98.00]; p<0.001). After three months most of the parameters seemed to have recovered, except for range of motion. Procedure-related increase in pain (i.e. NRS increase ≥ 1 point) was the most important independent predictor of shoulder impairment, in terms of Constant Score modification (r=0.570; p<0.001).

Conclusions: ICD implantation is frequently associated with ipsilateral shoulder impairment which tends to recover within 3-months. These data positively compare with the subpectoral approach and should be considered for future research regarding impact of ICD implant on physical well-being and quality of life.

Keywords: Heart failure; Implantable defibrillator; Shoulder impingement; Shoulder pain.

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