Abstract
Implantable cardioverter-defibrillators (ICDs) have a proven mortality benefit in appropriately selected people. Several retrospective studies, though, have postulated that appropriate ICD therapy may lead to fatal, pulseless electrical alternans (PEA). This case report describes an episode of transient PEA from myocardial stunning and standstill following defibrillation threshold testing. The risk of post-shock myocardial stunning and standstill should be kept in mind as a potential complication of testing. With rapid recognition and prompt intervention, this complication is potentially reversible.
References
Pires, L. A., Lehmann, M. H., Steinman, R. T., Baga, J. J., & Schuger, C. D. (1999). Sudden death in implantable cardioverter-defibrillator recipients: Clinical context, arrhythmic events and device responses. Journal of the American College of Cardiology, 33, 24–32.
Mitchell, L. B., Pineda, E. A., Titus, J. L., & Bartosch, P. M. (2002). Sudden death in patients with implantable cardioverter defibrillators. Journal of the American College of Cardiology, 39, 1323–1328.
Kern, K. B., Hilwig, R. W., Rhee, K. H., & Berg, R. A. (1996). Myocardial dysfunction after resuscitation from cardiac arrest: An example of global myocardial stunning. Journal of the American College of Cardiology, 28, 232–240.
Klouche, K., Weil, M. H., Sun, S., Tang, W., Povoas, H. P., Kamohara, T., et al. (2002). Evolution of the stone heart after prolonged cardiac arrest. Chest, 122, 1006–1011.
DeAntonio, H. J., Kaul, S., & Lerman, B. B. (1990). Reversible myocardial depression in survivors of cardiac arrest. Pacing and Clinical Electrophysiology, 13, 982–985.
Zaugg, C. E., Ziegler, A., Lee, R. J., Barbosa, V., & Buser, P. T. (2002). Postresuscitation stunning: Postfibrillatory myocardial dysfunction caused by reduced myofilament Ca2+ responsiveness after ventricular fibrillation-induced myocyte Ca2+ overload. Journal of Cardiovascular Electrophysiology, 13, 1017–1024.
Hurst, T. M., Hinrichs, M., Breidenbach, C., Katz, N., & Waldecker, B. (1999). Detection of myocardial injury during transvenous implantation of automatic cardioverter-defibrillators. Journal of the American College of Cardiology, 34, 402–408.
Schlüter, T., Baum, H., Plewan, A., & Neumeier, D. (2001). Effects of implantable cardioverter Defibrillator implantation and shock application on biochemical markers of myocardial damage. Clinical Chemistry, 47, 459–463.
Epstein, A. E., Kay, G. N., Plumb, V. J., Dailey, S. M., & Anderson, P. G. (1998). Gross and microscopic pathologic changes associated with nonthoracotomy implantable defibrillator leads. Circulation, 98, 1517–1524.
Schirmer, U., Hemmer, W., Lindner, K. H., Anhaupl, T., & Wieser T. (1997). Ultrastructural alterations in the right and left ventricular myocardium following multiple low energy endocardial countershocks in anesthetized dogs. Pacing and Clinical Electrophysiology, 20, 79–87.
Steinbeck, G., Dorwarth, U., Mattke, S., Hoffmann, E., Markewitz, A., Kaulbach, H., et al. (1994). Hemodynamic deterioration during ICD implant: Predictors of high-risk patients. American Heart Journal, 127, 1064–1067.
Runsiö, M., Bergfeldt, L., Brodin, L. Å., Ribeiro, A., Samuelsson, S., & Rosenqvist, M. (1997). Left ventricular function after repeated episodes of ventricular fibrillation and defibrillation assessed by transoesophageal echocardiography. European Heart Journal, 18, 124–131.
Poelaert, J., Jordaens, L., Visser, C. A., De Clerck, C., & Herregods, L. (1996). Transoesophageal echocardiographic evaluation of ventricular function during transvenous defibrillator implantation. Acta Anaesthesiologica Scandinavica, 40, 913–918.
Robin, J., Weinberg, K., Tiongson, J., Carnethon, M., Reddy, M., Ciaccio, C., et al. (2006). Renal dialysis as a risk factor for appropriate therapies and mortality in implantable cardioverter-defibrillator recipients. Heart Rhythm, 3, 1196–1201.
Cuculich, P. S., Sánchez, J. M., Kerzner, R., Greenberg, S. L., Sengupta, J., Chen, J., et al. (2007). Poor prognosis for patients with chronic kidney disease despite ICD therapy for the primary prevention of sudden death. Pacing and Clinical Electrophysiology, 30, 207–213.
Turakhia, M. P., Varosy, P. D., Lee, K., Tseng, Z. H., Lee, R., Badhwar, N., et al. (2007). Impact of renal function on survival in patients with implantable cardioverter-defibrillators. Pacing and Clinical Electrophysiology, 30, 377–384.
Joki, N., Hase, H., Saijyo, T., Tanaka, Y., Takahashi, Y., Ishikawa, H., et al. (2003). Combined assessment of cardiac systolic dysfunction and coronary atherosclerosis used to predict future cardiac deaths after starting hemodialysis. American Journal of Nephrology, 23, 458–465.
Paoletti, E., Specchia, C., Di Maio, G., Bellino, D., Damasio, B., Cassottana, P., et al. (2004). The worsening of LVH is the strongest predictor of SCD in HD patients: A 10 year survey. Nephrology Dialysis Transplantation, 19, 1829–1834.
Converse, R. L., Jacobsen, T. N., Toto, R. D., Jost, C. M., Cosentino, F., Fouad-Tarazi, F., et al. (1992). Sympathetic overactivity in patients with chronic renal failure. New England Journal of Medicine, 327, 1912–1918.
Aoki, J., Ikari, Y., Nakajima, H., Mori, M., Sugimoto, T., Hatori, M., et al. (2005). Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients. Kidney International, 67, 333–340.
Landray, M. J., Wheeler, D. C., Lip, G. Y., Newman, D. J., Blann, A. D., McGlynn, F. J., et al. (2004). Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: The chronic renal impairment in Birmingham (CRIB) study. American Journal of Kidney Diseases, 43, 244–253.
Morales, M., Gremigni, C., Dattolo, P., Piacenti, M., Cerrai, T., Fazi, A., et al. (1998). Signal-averaged ECG abnormalities in haemodialysis patients. Nephrology Dialysis Transplantation, 13, 668–673.
Covic, A., Diaconita, M., Gusbeth-Tatomir, P., Covic, M., Botezan, A., Ungureanu, G., et al. (2002). Haemodialysis increases QT(c) interval but not QT(c) dispersion in ESRD patients without manifest cardiac disease. Nephrology Dialysis Transplantation, 17, 2170–2177.
Wong, C. K., Pun, K. K., Cheng, C. H., Lau, C. P., Leung, W. H., Chan, M. K., et al. (1990). Hypocalcemic heart failure in end-stage renal disease. American Journal of Nephrology, 10, 167–170.
Ghent, S., Judson, M. A., & Rosansky, S. J. (1994). Refractory hypotension associated with hypocalcemia and renal disease. American Journal of Kidney Diseases, 23, 430–432.
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Mollerus, M., Naslund, L. Myocardial stunning following defibrillation threshold testing. J Interv Card Electrophysiol 19, 213–216 (2007). https://doi.org/10.1007/s10840-007-9150-9
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DOI: https://doi.org/10.1007/s10840-007-9150-9