This case report describes a patient with an automatic ICD who suffered a defibrillation shock without warning symptoms. An electrical interference can be observed in the stored EGM of the episode. The patient explained that the moment he felt the shock he was touching a washing machine. After correct grounding of this machine the patient did not suffer more inappropriate shocks.
Sinus node bradycardia or sinus node arrest is a documented phenomenon during radiofrequency catheter ablation. In addition, sinus node inhibition during ventricular pacing has been described as an infrequent occurrence in the course of diagnostic electrophysiology studies. The proposed mechanism in both situations is intense stimulation of vagal afferent pathways leading to a Bezold-Jarisch-like phenomenon. In the present report, we describe a series of three cases of atrial asystole during ventricular pacing following radiofrequency catheter ablation of accessory pathways. Potential pathophysiologic mechanisms are discussed.
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