Arterial embolism complicating implantable cardioverter defibrillator shocks with normal ventricular function

Area of Science:

• Cardiology
• Medical Devices
• Vascular Medicine

Background:

• Implantable cardioverter defibrillators (ICDs) are crucial for managing cardiac arrhythmias.
• Thromboembolic events are a known, albeit uncommon, complication associated with ICDs.
• Previous reports of emboli linked to ICDs often involved patients with impaired cardiac function.

Observation:

• A 69-year-old man presented with a right femoral artery embolus 24 hours post-ICD implantation.
• The patient received multiple ICD shocks during the early postoperative period.
• He had nonobstructive hypertrophic cardiomyopathy with preserved left ventricular function and no pre-existing thrombus.

Findings:

• The arterial embolus occurred in the absence of atrial fibrillation or other traditional thromboembolic risk factors.
• This case represents an arterial embolus potentially related to ICD shocks in a patient with normal systolic function.
• This contrasts with prior literature where such events were typically seen in patients with reduced ejection fraction.

Implications:

• This case suggests that arterial emboli may be a rare complication of ICD shocks even in patients with preserved cardiac function.
• Further investigation into the mechanisms linking ICD shocks to arterial thromboembolism in normofunctional hearts is warranted.
• Clinicians should maintain a high index of suspicion for embolic events following ICD implantation and defibrillation, irrespective of baseline cardiac function.