Complete pacemaker failure following lightning strike injury: A case report.

Area of Science:

• Cardiology
• Biomedical Engineering
• Electrical Engineering

Background:

• Modern cardiovascular implantable electronic devices (CIEDs) possess protective mechanisms against external electric shocks.
• Malfunctions in CIEDs following accidental electrocution are infrequent.
• The specific impact of lightning injuries on patients with CIEDs remains largely uncertain.

Observation:

• A 74-year-old male with a dual-chamber pacemaker, implanted for complete heart block, was struck by lightning while engaged in farming.
• Initially, the patient reported no significant injuries but presented a month later with asymptomatic bradycardia.
• Device interrogation revealed substantial damage to the pacemaker's battery and leads.

Findings:

• Unlike previous reports of minor pacing threshold elevation, this case demonstrated extensive damage to the entire pacing system.
• The patient required extraction of the compromised system and implantation of a new pacing system.
• Factors influencing the severity of device damage, including injury mechanism, pacemaker model, and current dispersion, are yet to be fully elucidated.

Implications:

• Lightning strikes pose a significant, albeit rare, risk of severe damage to cardiovascular implantable electronic devices.
• Healthcare providers should consider the potential for CIED malfunction in patients with a history of lightning exposure.
• Further research is needed to understand the variables affecting CIED response to lightning strikes and to refine protective strategies.