Unnecessary shock from an implantable cardioverter-defibrillator following transcutaneous pacing

Area of Science:

• Cardiology
• Medical Device Technology
• Emergency Medicine

Background:

• Increasing prevalence of cardiovascular disease and aging populations lead to more patients with implantable cardioverter-defibrillators (ICDs).
• Emergency department physicians must manage patients with complex medical histories and implanted devices.
• Understanding potential interactions between medical interventions and ICDs is crucial for patient safety.

Observation:

• A patient with a known ICD presented to the emergency department.
• The patient required management for bradycardia.
• Transcutaneous pacing was initiated for bradycardia treatment.

Findings:

• Transcutaneous pacing in a patient with an ICD led to an unintended device shock.
• The shock was unnecessary and likely a result of pacing-induced electromagnetic interference.

Implications:

• Highlights the critical need for emergency physicians to be aware of ICD function and potential interactions with external medical procedures.
• Emphasizes the importance of device interrogation and programming considerations when managing patients with ICDs.
• Underscores the potential for adverse events when medical interventions are not carefully considered in the context of implanted cardiac devices.