Multiple shocks from ICDs can burn subcutaneous tissue: Case report

A new report published in Heart Rhythm Case Reports shows that Multiple shocks from implanted cardioverter defibrillators (ICDs) can result in subcutaneous tissue burns, as revealed by PET imaging for the first time.

Since clinical trials revealed that implanted cardioverter defibrillators lower mortality in a subset of individuals with cardiac disease, their usage has rapidly grown. The benefit of these devices is that they can treat malignant ventricular arrhythmias with high-energy shocks and anti-tachycardia pacing to lessen sudden cardiac death (SCD). Here, Christopher Perez and colleagues discussed the case of a 22-year-old man who suffered thermal harm from the ICD as a result of frequent defibrillations.

A 22-year-old guy was brought to the hospital for several acceptable ICD shocks after a history of myocarditis, ventricular fibrillation, and past out-of-hospital cardiac arrest status following single chamber ICD implantation. His medical background was significant for unknown gene alterations such as KCNH2, PKP2, and TTN. Prior to this stay, he claimed good health, frequent exercise, and no ICD discharge since placement. He admitted to not taking sotalol. The patient claimed hard exercise before to receiving fifteen shocks. The physical examination revealed discomfort and visible swelling at the location of the implantation, but no temperature. Interrogation of the device indicated monomorphic ventricular tachycardia at 300 beats per minute. Troponin levels began at 0.39 ng/mL (0.0-0.9 ng/mL) and peaked at 20.98 ng/mL.

A chest ultrasound revealed no signs of fluid accumulation or soft tissue abnormalities. An echocardiography revealed normal left ventricular function (ejection fraction 55-60%), normal diastolic function, and moderately dilated right atrium and ventricle. A cardiac MRI revealed non-specific left ventricular wall weakening and delayed gadolinium enhancement, indicating an infarct rather than a preceding infectious or inflammatory condition like myocarditis or sarcoidosis. In addition, due to inflammation caused by repeated ICD shocks, there was enhanced FDG activity posterior to the ICD along the anterior left pectoralis major muscle. His episode of ventricular tachycardia was eventually shown to be scar-mediated. On discharge, Sotalol was restarted, and the patient was referred for catheter-based ablation.

Given the possible long-term effects of soft tissue injury, such as chronic pain or functional impairment, further study in this area is needed to clarify the impact of ICD shocks on soft tissue structures and to create appropriate treatment measures. A better knowledge of the soft tissue effects of ICD shocks can aid clinical practice and enhance patient outcomes.

Reference:

Perez, C., Banchs, J. E., Strober, M. D., & Mixon, T. A. (2023). An Uncommon Case of Thermal Burn from Repetitive Implantable Cardioverter-Defibrillator Shocks Seen on Positron Emission Tomography/Computed Tomography Scan. In Heart Rhythm Case Reports. Elsevier BV. https://doi.org/10.1016/j.hrcr.2023.05.007