Introduction Implantable cardioverter-defibrillator (ICD) to monitor and promptly treat life-threatening arrhythmia has been a very successful approach. However, inappropriate defibrillation could increase morbidity and mortality. Most common causes of inappropriate defibrillation are: supra-ventricular arrhythmia and device malfunctions.
Case Description A 31-year-old female with arrythmogenic right ventricular cardiomyopathy (ARVC) status post dual chamber ICD presented after her ICD had fired. Patient was sitting near a public swimming pool and suddenly felt a jolt, “getting hit at the back of the head”. On further ICD Interrogation revealed a high frequency artifact on the intra-cardiac electrogram which was sensed by the device as ventricular fibrillation, and subsequently it was defibrillated. Other parameters including sensing and pacing thresholds, lead impedances were all within normal limits.
Discussion Alternating current from a nearby electric generator created Electro-magnetic interference (EMI) which led to inappropriate defibrillation. High frequency oscillating artifact is the hallmark of EMI from alternating current. We should be aware of all possible causes that can interfere with cardiac devices. .
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