- Case Study
- Open Access
Perioperative management of a patient with subcutaneous defibrillator undergoing cardiac surgery
© Infusino et al. 2015
- Received: 31 July 2015
- Accepted: 7 September 2015
- Published: 21 September 2015
We describe a case of inappropriate shocks due to temporary epicardial pacing after cardiothoracic surgery in a patient with a subcutaneous ICD.
- Subcutaneous defibrillator
- Inappropriate shock
- Temporary pacing
- Cardiac surgery
The management of an S-ICD during and after surgical procedures is not addressed by current recommendations (Crossley et al. 2011). According to our experience, cardiac surgery through median sternotomy is feasible in the setting of a previously implanted S-ICD system, but care must be taken to avoid cautery application to the lead, and placing the metal sternal wires in contact with the lead. If post-operative pacing is required, it is strongly advised to use bipolar wires and to carefully program the pacemaker (e.g. low pacing output, low pacing rate, single chamber pacing mode, etc.). In addition, appropriate lead location and S-ICD sensing should be reconfirmed postoperatively (considering also possible occurrence of pacing), with consideration of the optimal sensing vector as well.
TI Responsible for conception of the case and for paper writing; SV reviewer of the paper for technical content; MR technical support during procedures; DM responsible for patient’s management and for data collection. All authors read and approved the final manuscript.
Compliance with ethical guidelines
Competing interests S. Valsecchi and M. Rigano are employees of Boston Scientific, Inc. No other conflicts of interest exist.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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