Unexpected early complication of implantable-cardioverter defibrillator

Abstract

A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

Effects and Complications of Subcutaneous Implantable Cardioverter-Defibrillator in the Prevention of Sudden Cardiac Death: A Narrative Review

“…The prevalence rate of inappropriate shocks, which are defined as an ICD shock for any condition other than ventricular arrhythmias or sustained ventricular tachycardia, is not regarded as an ICD-related problem, but rather as a distinct unfavorable event. Complications were divided into major and minor [ 21 ]. Over a median follow-up of 28.7 months (interquartile range: 25.2-33.7 months), 230 issues have been reported in 195 (13.5%) patients at a rate of 6.7 per 100 persons.…”

“…Patients experienced their first issue 14 days (interquartile range: 1-96 days) after the ICD was installed [ 20 ]. Early ICD complications can also have some differential diagnoses, such as ventricular arrhythmia, myocardial infarction, cardiomyopathy, spontaneous coronary dissection, and pulmonary embolism [ 21 ].…”