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Erosion of an extrapericardial implantable cardioverter defibrillator patch through the gastric fundus with fistulous tract formation.

Until as recently as the mid-1990s, implantable cardioverter defibrillator (ICD) leads were placed through thoracotomy as anterior and/or posterolateral patches. The defibrillator patches have reportedly been associated with a number of relatively common mechanical complications as well as less common complications, including patch migration or erosion into contiguous structures. We report a previously unreported late complication of epicardial defibrillator patch placement in which patch migration and erosion through the gastric fundus resulted in fistulous tract formation from the mediastinum to the lumen of the stomach. Although surgically implanted epicardial patch defibrillator systems are relatively uncommon in current U.S. practice, these devices are still used when specific anatomic or electrophysiological considerations preclude the use of more common endocardial lead systems. Several thousand patients with epicardial patch leads in place are still believed to be alive in the United States. In these patients, continued vigilance for lead-related complications is appropriate. Prompt surgical intervention is usually warranted when patch migration or complications such as the one described occur.