Implantable cardioverter defibrillator shock embolizes an atrial septal occluder device in Brugada syndrome

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Brugada syndrome patients with ventricular arrhythmias often require implantable cardioverter defibrillators (ICDs).
• Atrial septal defects (ASDs) in these patients necessitate closure to prevent paradoxical embolism from ICD leads.
• This case highlights a rare co-occurrence of Brugada syndrome and a large ASD.

Observation:

• A 15-year-old male with Brugada syndrome underwent transvenous ICD placement and device closure of a large ASD.
• During defibrillation threshold testing, an induced ventricular fibrillation was terminated by a shock.
• The shock caused a sudden body movement, leading to embolization of the ICD into the left atrium.

Findings:

• The ICD device embolized into the left atrium due to sudden movement during defibrillation testing.
• Successful retrieval of the embolized ICD was performed.
• The atrial septal defect was subsequently closed with a larger device.

Implications:

• This case presents an unreported complication of device closure in conjunction with ICD implantation for Brugada syndrome.
• It underscores the importance of considering mechanical complications during device testing in patients with concurrent ASDs.
• Successful management involved device retrieval and revision of the ASD closure, offering insights for similar rare scenarios.