Inappropriate shock and percutaneous cardiac intervention: A lesson to learn in the cath lab

Abstract

Coronary disease is a common condition in patients affected by heart failure with severely reduced ejection fraction (HFrEF). This condition represents an indication for implantable cardioverter defibrillator (ICD) in order to reduce the risk of sudden death related to arrhythmias. Nevertheless, inappropriate shocks are associated with worse quality of life, hospitalization, and death. We present the case of an inappropriate shock related to percutaneous coronary intervention during the insertion and advancement of the guidewire into the left anterior descending artery (LAD) in a patient with an ICD. Physicians’ awareness about the clinical implication of noise arising during a coronary procedure is very important in patients with an ICD or pacemaker, to avoid inappropriate shock or pacing inhibition and to raise the possibility of lead implantation in or helix protrusion into the coronary lumen.

Ventricular fibrillation count by noise oversensing in a cardiac resynchronization therapy‐defibrillator induced by side branch protection during percutaneous coronary intervention

“…Previous reports have described inappropriate shock delivery because of noise oversensing in an implantable cardioverter‐defibrillator device during PCI 1,2 . A case report 1 demonstrated that LAD guidewires had actual contact with the helix tip of RV leads, which were screwed into the right mid‐anterior septum, and the intermittent discrete noise signals might be caused by the wire‐helix mechanical interaction. However, noise oversensing in our case occurred during the insertion of the second guidewire into the diagonal branch, which was far from the RV lead helix tip.…”

“…From this intermittent discrete potential and circumstantial evidence, myopotential, lead fraction, and external electromagnetic interference are unlikely. Previous reports have described inappropriate shock delivery because of noise oversensing in an implantable cardioverter‐defibrillator device during PCI 1,2 . A case report 1 demonstrated that LAD guidewires had actual contact with the helix tip of RV leads, which were screwed into the right mid‐anterior septum, and the intermittent discrete noise signals might be caused by the wire‐helix mechanical interaction.…”