Termination of Electrocution-Induced Ventricular Fibrillation by an Implantable Cardioverter Defibrillator

Abstract

We describe a case in which an implantable cardioverter defibrillator (ICD) saved a patient's life after he tried to commit suicide by electrocuting himself. Deaths caused by electrocution are usually accidental and rarely suicidal. The amount of current flow is the most important factor in deciding the degree of electrical injury, which may range from transient muscle tremors to death. The ICD is electrically insulated from surrounding electromagnetic interference and the passage of electric current typically does not damage or reprogram the device. In our patient, electromagnetic interference caused by the electric current initially triggered the noise reversion mode, leading to asynchronous pacing. Ventricular fibrillation was detected and terminated only after the electromagnetic interference stopped, as depicted by the intracardiac electrogram. This case is the first documented example of an ICD-aborted fatal electrocution from ventricular fibrillation caused by an unnatural electrical source. (PACE 2010; 510-512).

Defibrillation success rates for electrically-induced fibrillation: Hair of the dog

“…19 The second case involved a suicidal electrician that intentionally grabbed onto a 240 VAC source. 20 The ICD detected a rather rapid VF (cycle length 181 ± 42 ms) with several zero-crossings not reflected in the detected cycle lengths. In both cases, the ICD detected the VF and converted it back to sinus rhythm.…”

An inappropriate pacing threshold increase after repeated electrical storm in a patient with implantable cardioverter defibrillator

“…It is generally defined as the occurrence of three or more obvious episodes of VT /VF in 24 h, separated by bouts of normal rhythm after successful therapy, either ATP burst or shock [ 6 ]. Previous studies have shown that ES occurs in about 10 – 28% of ICD recipients and is associated with increased mortality [ 7 ]. The first therapy for ES is eliminating the risk factors as soon as possible, then following a positive comprehensive management protocol [ 8 ].…”

Failure of a Vagus Nerve Stimulator following a Nearby Lightning Strike

“…Other implanted electrical devices have been reported to malfunction after experiencing unanticipated electrical interference, such as pacemakers and implantable loop recorders [3,4]. Interestingly, direct electrical interference does not appear to affect the function of implanted cardioverter defibrillators, which have been reported to remain intact and have functioned to resuscitate patients immediately after electrocution [5,6,7,8]. Iatrogenic and potentially avoidable electromagnetic interference has been reported for several implanted electrical devices, notably from electrocautery and ablation procedures [9,10].…”