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.
KeywordsSubcutaneous defibrillator Inappropriate shock Temporary pacing Sternotomy 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.
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- Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK et al (2011) The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm 8:1114–1154View ArticleGoogle Scholar
- Gelissen M, Debie L, van Opstal J (2010) Inappropriate implantable cardioverter-defibrillator shocks due to temporary epicardial pacing. Europace 12:1648View ArticleGoogle Scholar