Subcutaneous-implantable cardioverter defibrillator lead dislodgement in a juvenile catecholamine-induced polymorphic ventricular tachycardia patient

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a relatively rare inherited arrhythmic disease that causes sudden cardiac death, and is caused by mutations in the cardiac ryanodine receptor (RyR2) or sarcoplasmic reticulum protein calsequestrin 2 gene (CASQ2). A 16-year-old man was diagnosed with CPVT and was implanted with a Subcutaneous-implantable Cardioverter Defibrillator (S-ICD), but defibrillation electrode detachment occurred early after placement. We suspected that a two-incision technique was the possible cause. We also report on changes in surface ECG in remote monitoring of the device. TAKE HOME MESSAGE Although two-incision techniques are becoming the mainstream method of S-ICD implantation, we should consider that the three-incision technique may be advantageous in highly active patients. Remote monitoring may also be useful for early detection of S-ICD dislodgement.

Subcutaneous Implantable Cardioverter-Defibrillator Lead Dislodgement Masquerading as Left Shoulder Pain

“…Some of the risk factors associated with twiddler’s syndrome are female gender, obesity, pediatric or elderly population, psychiatric illness history, and device-pocket size mismatch [ 8 ]. Another case report demonstrated LMD in a 16-year-old patient with S-ICD found incidentally on chest radiography, which was suspected to be secondary to strenuous exercise shortly after the procedure [ 9 ]. Our patient also presented with worsening pain and new-onset swelling after movement in his sleep, which could have caused some mechanical force and manipulation of the device.…”