Singh Manavotam, Brar Vijaywant, Alexander Nebu, Tashayyod Rustin, O'Donoghue Susan, Worley Seth J
Cardiac Electrophysiology MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
MedStar Washington Hospital Center, Washington, DC, USA.
J Innov Card Rhythm Manag. 2021 Nov 15;12(11):4780-4784. doi: 10.19102/icrm.2021.121105. eCollection 2021 Nov.
Left ventricular assist devices (LVADs) provide circulatory support to patients with severe left ventricular systolic dysfunction. Many such patients have a pre-existing implantable cardioverter-defibrillator (ICD) at the time of their LVAD surgery. LVAD implantation can alter the ICD lead parameters, including R-wave sensing, right ventricular capture threshold, and impedance. These changes can in turn affect the ability of the ICD to successfully treat malignant ventricular arrhythmias. In most patients who present with ineffective ICD shocks, the failed shock is assumed to be secondary to the patient's severe cardiomyopathy. Especially, the role of physical examination in such patients is often minimized. In our patient, a thorough history-taking and history-guided physical examination led us to the root cause of the failed ICD shocks. Our patient was noted to have a metal tongue piercing, which was the likely cause of his ineffective ICD shocks. Our case highlights the importance of a comprehensive history-taking and physical examination.
左心室辅助装置（LVAD）为严重左心室收缩功能障碍的患者提供循环支持。许多此类患者在进行LVAD手术时已预先植入了植入式心脏复律除颤器（ICD）。LVAD植入可改变ICD导线参数，包括R波感知、右心室起搏阈值和阻抗。这些变化进而会影响ICD成功治疗恶性室性心律失常的能力。在大多数出现ICD电击无效的患者中，电击失败被认为是继发于患者严重的心肌病。特别是，体格检查在这类患者中的作用常常被忽视。在我们的患者中，全面的病史采集和基于病史的体格检查使我们找到了ICD电击失败的根本原因。我们的患者被发现有金属舌环，这可能是他ICD电击无效的原因。我们的病例强调了全面病史采集和体格检查的重要性。
