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Fatal inappropriate ICD shock.

Christian Veltmann1, Martin Borggrefe, Rainer Schimpf

  • 1Department of Medicine, University Hospital Mannheim, Mannheim, Germany. christian.veltmann@med.ma.uni-heidelberg.de

Journal of Cardiovascular Electrophysiology
|February 24, 2007
PubMed
Summary
This summary is machine-generated.

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A dislodged implantable cardioverter defibrillator (ICD) lead caused fatal ventricular fibrillation due to inappropriate shocks. Immediate ICD interrogation and deactivation are crucial for dislodged leads to prevent life-threatening arrhythmias.

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Inappropriate implantable cardioverter defibrillator (ICD) therapy poses a risk of ventricular proarrhythmia.
  • This case highlights an extremely rare fatal arrhythmia induced by inappropriate ICD shocks.

Observation:

  • A dislodged ventricular lead sensed atrial signals during sinus tachycardia, triggering inappropriate ventricular fibrillation detection.
  • Subsequent inappropriate shocks escalated to fatal ventricular fibrillation, which was undersensed due to lead dislodgement.

Findings:

  • The fourth inappropriate ICD shock induced ventricular fibrillation.
  • The dislodged lead failed to sense the induced ventricular fibrillation due to low amplitude signals.
  • The ICD initiated antibradycardic pacing during ventricular fibrillation.

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Implications:

  • Immediate ICD interrogation and deactivation are essential following inappropriate therapy, especially with a dislodged lead.
  • Intensive care monitoring is critical for patients with dislodged leads until lead revision.
  • This case underscores the importance of device management to prevent life-threatening complications from implantable cardioverter defibrillators.