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Emergency department management of patients with automatic implantable cardioverter-defibrillators
1Department of Emergency Medicine, Charlotte Memorial Hospital, North Carolina 28232.
Insights
A patient with dilated cardiomyopathy experienced inappropriate shocks from an automatic implantable cardioverter-defibrillator (AICD) during atrial fibrillation. Management involved rate control and AICD deactivation to manage these complications.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Idiopathic dilated cardiomyopathy presents a significant risk for ventricular arrhythmias.
- Automatic implantable cardioverter-defibrillators (AICDs) are crucial for managing life-threatening arrhythmias.
Observation:
- A patient with idiopathic dilated cardiomyopathy and ventricular arrhythmias received an AICD.
- The patient experienced multiple inappropriate AICD discharges during an episode of atrial fibrillation with rapid, wide complex ventricular response.
Findings:
- Inappropriate AICD shocks are a recognized complication, particularly during atrial fibrillation.
- Management included intravenous verapamil for rate control and temporary AICD deactivation.
Implications:
- This case highlights the importance of recognizing and managing AICD inappropriate shocks.
- Effective strategies are needed to prevent AICD malfunction during supraventricular tachyarrhythmias.
Abstract:
The case of a patient with idiopathic dilated cardiomyopathy and complex ventricular arrhythmias who underwent placement of an automatic implantable cardioverter-defibrillator (AICD) and experienced inappropriate shocks during atrial fibrillation is presented. On presentation to the emergency department, the patient had experienced approximately ten device discharges over six hours. ECG revealed atrial fibrillation with a rapid, wide complex ventricular response. Initial management consisted of IV verapamil for rate control followed by deactivation of the AICD. The patient was subsequently hospitalized for treatment of atrial fibrillation. Inappropriate device discharges, a frequently reported AICD-associated complication, are discussed.