Reflection: Patient with ICD on fire! | Figure 1

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Emergency Medicine

Reflection: Patient with ICD on fire!

Man in 60s brought by ambulance with infective respiratory symptoms (cough, fever, later found to be flu A+), his ICD/pacemaker for an underlying cardiac condition had fired more than 20 times. His ECG showed AF (known) with RBBB and runs of VT triggering ICD activation. The ICD was not defective, rather it was saving the patient’s life every time it fired. His infection was driving a fast AF which degenerated into VT, causing the ICD to fire and cardiovert the patient to the intended atrial-sensed ventricular-paced rhythm.

I loaded the patient with amiodarone, magnesium sulphate, and gave him his daily dose of bisoprolol 5 mg, but also focused on the treatment of infection as the underlying culprit in this presentation. The dual approach of treating the infection and administering antiarrhythmic medication ultimately reverted the patient to his original rhythm after a couple of hours.

Understanding the sequence of pathologies leading to one another is vital to adopting the right treatment strategy - was my take-home lesson.

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