An “UninTENSional” Subcutaneous Implantable Cardioverter-defibrillator Shock

Abstract

Subcutaneous implantable cardioverter-defibrillators (ICDs) (S-ICDs) are advantageous because they eliminate the need for transvenous leads. However, just like in the case of traditional ICDs, inappropriate shocks are an unwanted complication that may result following their placement. In this case, we discuss the mechanism of an inappropriate shock in a patient with an S-ICD.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

“…In contrast to DBS and SCS, there are more reported adverse interactions between CIED and TENS units. Both Singh et al [ 14 ] and Shenoy et al [ 15 ] reported EMI from a TENS unit that resulted in an ICD shock. Singh et al [ 14 ] details a S-ICD shock after a patient underwent TENS therapy in the neck, axilla, and back.…”

“…Both Singh et al [ 14 ] and Shenoy et al [ 15 ] reported EMI from a TENS unit that resulted in an ICD shock. Singh et al [ 14 ] details a S-ICD shock after a patient underwent TENS therapy in the neck, axilla, and back. This adverse interaction was likely due to the relatively superficial location of the S-ICD and its increased susceptibility to EMI, which ultimately led to an ICD shock after the device detected low-amplitude and high frequency signals[ 14 ].…”

“…Singh et al [ 14 ] details a S-ICD shock after a patient underwent TENS therapy in the neck, axilla, and back. This adverse interaction was likely due to the relatively superficial location of the S-ICD and its increased susceptibility to EMI, which ultimately led to an ICD shock after the device detected low-amplitude and high frequency signals[ 14 ]. Shenoy et al [ 15 ] further documents ICD and TENS interaction even in a patient with a transvenous ICD, who underwent TENS therapy in an unreported anatomic location.…”

Extracardiac Inappropriate Shocks in Subcutaneous Implantable Cardioverter Defibrillator: Management in Emergency Department

“…Also, there is a likely assertation bias because normal functioning devices are unlikely to be reported. In this regard, we only found twenty-two such reports of S-ICD with confirmed lack of EMI and MP in the literature [9,10,14,15,[18][19][20][21]25,27,[28][29][30][33][34][35][36][37]42,43,47,48]. It is noteworthy that the largest published patient series of S-ICD demonstrated that 0.5% to 8% of patients experienced EMI or MP [7,18].…”