Implantable Cardioverter-Defibrillator Shock after Stenting Across the Device Leads

Area of Science:

• Cardiology
• Interventional Radiology
• Biomedical Engineering

Background:

• A patient with nonischemic cardiomyopathy and end-stage renal disease had a cardiac resynchronization therapy defibrillator (CRT-D) for 5 years.
• The patient underwent stenting of a partially occluded subclavian vein to treat arteriovenous fistula stenosis for hemodialysis.

Observation:

• Following the stenting procedure, the CRT-D delivered an inappropriate shock.
• Device interrogation revealed lead damage caused by the stent, resulting in electrical noise and intermittent discharges.

Findings:

• The inappropriate defibrillator discharge was directly linked to lead damage from the subclavian vein stent.
• This complication led to the patient's insistence on device removal, ultimately resulting in a cardiac arrest and severe neurological damage.

Implications:

• This case underscores the critical need for collaboration between interventional radiologists and electrophysiologists when procedures involve patients with implanted cardiac devices.
• Careful consideration of lead placement and potential interactions with vascular interventions is crucial to prevent life-threatening complications.
• This is the first reported instance of inappropriate defibrillator discharge caused by lead damage secondary to stenting across the leads in a patient with nonischemic cardiomyopathy and end-stage renal disease.