Inappropriate Implantable Cardioverter-Defibrillator Shocks Attributed to Alternating-Current Leak in a Swimming Pool

Abstract

Attributed to Alternating-Current Leak in a Swimming Pool Implantable cardioverter-defibrillators (ICDs) I mplantable cardioverter-defibrillators (ICDs) provide primary and secondary prevention of sudden cardiac death in patients who are predisposed to malignant ventricular arrhythmias.1-3 Despite the clinical efficacy and improved technical specifications of newer ICDs, inappropriate shocks can still affect patients who have implanted devices. We review the case of a patient whose inappropriate ICD shocks were most likely caused by the leakage of small amounts of alternating current in a swimming pool. Case ReportA 63-year-old man with a history of atrial fibrillation, coronary artery disease, myocardial infarction, multivessel coronary artery bypass grafting, and ischemic cardiomyopathy presented at our electrophysiology clinic for device interrogation. Two months earlier, the patient's previous permanent pacemaker had been upgraded to a biventricular ICD: a Protecta XT model D314TRG CRT-D ( The patient had experienced 2 distinct device discharges immediately after jumping into a swimming pool while vacationing in St. Lucia approximately 2 weeks before the current presentation. He described no prodromal symptoms, chest pain, palpitations, dizziness, syncope, or aftereffects. A cardiologist in St. Lucia had ruled out ischemia, heart failure, and electrolyte disturbances.Interrogation of the ICD revealed 2 shocks for electrical activity that the device had interpreted as ventricular fibrillation (Fig. 1). The remainder of the interrogation report revealed normal function, sensing, and evaluation of thresholds by iterative output testing; 3 unrelated episodes of paroxysmal atrial fibrillation had not evoked therapy. The discharges corresponded with the times when the patient was in the swimming pool.

A shocking experience: inappropriate subcutaneous implantable cardioverter-defibrillator shock at a public swimming pool

“…Similar cases of inappropriate ICD therapy at swimming pools have been reported with transvenous ICDs previously. 3 The S-ICD however, uses a different sensing method with higher chance of far-field interference. Its susceptibility to EMI is yet to be determined.…”

Hybrid bodies and the materiality of everyday life: how people living with pacemakers and defibrillators reinvent everyday routines and intimate relations

“…11 High radio frequency may interfere with the proper working of both pacemakers and ICDs. A minimal amount of electricity, caused by the leakage of insufficiently grounded appliances, may be enough to induce unnecessary ICD shocks because the implant may interpret the electric current as a heart rhythm disturbance, particularly the latest-generation defibrillators that can detect minimal levels of electric activity (Makaryus et al 2014).…”

Swimming pool saline chlorination units and implantable cardiac devices: A source for potentially fatal electromagnetic interference

“…Electromagnetic interference (EMI) resulting in inappropriate implantable cardioverter-defibrillator (ICD) shocks or pacemaker inhibition is particularly dangerous while swimming 1 . Although incidents of EMI from alternating current (AC) electrical faults in pools have been described in the literature, they have been sporadic 2, 3, 4, 5. In this series, we describe a new source of EMI within saline chlorination/electrolytic pool cleaning systems.…”