(FIT)-Module 5 Workshop 8: Device Cases-Ellenbogen Case 7 Answer

Video Transcription

Video Summary

The shock in the patient was likely caused by cardiac perforation involving the ICD-Lead. This resulted in over-sensing of diaphragmatic myopotentials and an inappropriate shock. Lead revision was performed, but there was no presence of pericardial effusion. The noise observed was only on the electrograms recording tip of the ICD-Lead in the right ventricle. There was no change in coil impedance, but there was an increase in threshold and a decrease in the R-wave. This could be due to lead fracture or insulation failure, which may not always be visible. Electromagnetic interference does not affect the electrical characteristics of the lead. A chest X-ray can provide a visual of this scenario.

Keywords

cardiac perforation

ICD-Lead

over-sensing

lead fracture

chest X-ray