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EP News: Case Reports

  • T. Jared Bunch
    Correspondence
    Address reprint requests and correspondence: Dr T. Jared Bunch, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132.
    Affiliations
    Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Published:October 05, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.002
      Subcutaneous implantable cardioverter-defibrillators (ICDs) have a similar efficacy to traditional transvenous devices without complications associated with dependence on transvenous leads, but the technology is associated with higher rates of inappropriate shocks. Perel et al (doi:https://doi.org/10.1016/j.hrcr.2022.09.001) shared a case of a 66-year-old man with nonischemic and valvular cardiomyopathy with a history of ventricular tachycardia (VT). He had a traditional ICD that was extracted because of infective endocarditis and replaced with a subcutaneous ICD. He presented with a witnessed out-of-hospital cardiac arrest with family members performing cardiopulmonary resuscitation (CPR). Upon emergency medical services arrival, he was intubated and chest compressions were continued with an automated machine. CPR was performed for an estimated 27 minutes without placement of a magnet over the ICD. Emergency providers noted multiple ICD shocks felt to be due to ventricular fibrillation storm. Upon hospital arrival, he was in idioventricular rhythm and device interrogation revealed that he has received 21 inappropriate shocks during CPR in the setting of asystole or bradycardia. This case highlights the risk of inappropriate shocks during CPR with subcutaneous ICDs and prompts awareness of the need to place a magnet over these devices during CPR.
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